JP4480978B2 - Medical treatment tool - Google Patents

Medical treatment tool Download PDF

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JP4480978B2
JP4480978B2 JP2003349572A JP2003349572A JP4480978B2 JP 4480978 B2 JP4480978 B2 JP 4480978B2 JP 2003349572 A JP2003349572 A JP 2003349572A JP 2003349572 A JP2003349572 A JP 2003349572A JP 4480978 B2 JP4480978 B2 JP 4480978B2
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wire
sheath
holding member
medical treatment
wire holding
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JP2005110984A (en
JP2005110984A5 (en
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諭 宮本
紀夫 大西
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Olympus Corp
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Olympus Corp
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Priority to JP2003349572A priority Critical patent/JP4480978B2/en
Priority to PCT/JP2004/015004 priority patent/WO2005034770A1/en
Priority to EP04792251A priority patent/EP1683492B1/en
Publication of JP2005110984A publication Critical patent/JP2005110984A/en
Priority to US11/399,538 priority patent/US8118819B2/en
Publication of JP2005110984A5 publication Critical patent/JP2005110984A5/ja
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12009—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
    • A61B17/12013—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot for use in minimally invasive surgery, e.g. endoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0417—T-fasteners
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A61B2017/0477—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery with pre-tied sutures
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B2017/0496—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials for tensioning sutures

Description

本発明は、体腔内に挿入し、生体組織に対して所定処理、例えば、結紮や縫合等を行う医療用処置具に関する。   The present invention relates to a medical treatment instrument that is inserted into a body cavity and performs predetermined processing, for example, ligation or suturing, on a living tissue.

現在、内視鏡の処置具チャンネルに挿通することにより体腔内に挿入し、生体組織に対して、所定の処理、例えば、結紮、縫合、生体サンプルの入手を行う医療用処置具は、様々なものが提供されている。この種の医療用処置具の１つとして、体腔内の病変部を結紮ワイヤにより結紮すると共に結紮した該結紮ワイヤを切断する操作を、一連の操作で行うことができる医療用結紮装置が知られている（例えば、特許文献１参照）。
この医療用結紮装置は、生体内に留置される医療用結紮具と、該医療用結紮具を体内に誘導して結紮操作を行う操作装置とを備えている。医療用結紮具は、基端側に折り返し部を有する上記結紮ワイヤと、該結紮ワイヤを折り返し部の前方で進退自在に固定する固定部材とを有している。該固定部材は、第１部材と第２部材とから構成されている。 At present, there are various medical treatment tools that are inserted into a body cavity by being inserted into a treatment tool channel of an endoscope, and perform predetermined processing, such as ligation, suturing, and acquisition of a biological sample, on a biological tissue. Things are offered. As one type of medical treatment tool of this type, there is known a medical ligation apparatus capable of performing a series of operations for ligating a lesion in a body cavity with a ligation wire and cutting the ligated wire. (For example, refer to Patent Document 1).
This medical ligation apparatus includes a medical ligation tool that is placed in a living body, and an operation device that guides the medical ligation tool into the body and performs a ligation operation. The medical ligation tool includes the ligation wire having a folded portion on the proximal end side, and a fixing member that fixes the ligature wire in a forward and backward direction in front of the folded portion. The fixing member is composed of a first member and a second member.

上記第１部材は、円筒状に形成され、先端側に設けられた圧入部と、基端側に設けられた環状の切断刃を有する大径部とを有している。この大径部の外周面には、係合爪が形成されている。また、第２部材は、円筒状に形成された第１部材の先端側に進退自在に配され、内部に上記圧入部が圧入される固定用内腔と、円筒部の外周に設けられて前記係合爪に係合可能な係合孔とを有している。
また、上記結紮ワイヤは、第２部材の先端から固定用内腔内を通って円筒部の側孔から外部に出て、更に、第１部材の大径部の基端側に設けられたワイヤガイドから内部に導かれて上記折り返し部となっている。 The first member is formed in a cylindrical shape, and has a press-fit portion provided on the distal end side and a large-diameter portion having an annular cutting blade provided on the proximal end side. An engaging claw is formed on the outer peripheral surface of the large diameter portion. Further, the second member is arranged to be movable forward and backward on the distal end side of the first member formed in a cylindrical shape, and is provided on the outer periphery of the cylindrical portion and the fixing lumen into which the press-fitting portion is press-fitted. An engaging hole engageable with the engaging claw.
The ligating wire passes from the distal end of the second member through the fixing lumen to the outside through the side hole of the cylindrical portion, and is further provided on the proximal end side of the large-diameter portion of the first member. The folded portion is guided from the guide to the inside.

上記操作装置は、上記第２部材の基端側に当接する内側シースを有しており、該内側シースの基端側は、指かけリングを有する操作部本体が接続されている。また、操作部本体には、該操作部本体に対して進退自在なスライダが取り付けられており、該スライダには、内側シース内に挿通されて先端に係合部材を有する操作ワイヤが接続されている。この係合部材は、結紮ワイヤの上記折り返し部に係合するようになっている。即ち、操作部本体を固定した状態でスライダを進退操作することにより、結紮ワイヤを拡径又は縮径できるようになっている。   The operating device has an inner sheath that abuts on the proximal end side of the second member, and an operating portion main body having a finger ring is connected to the proximal end side of the inner sheath. Further, a slider that can be moved forward and backward with respect to the operation unit main body is attached to the operation unit main body, and an operation wire that is inserted into the inner sheath and has an engagement member at the tip is connected to the slider. Yes. The engaging member is adapted to engage with the folded portion of the ligature wire. That is, the diameter of the ligature wire can be increased or decreased by moving the slider forward and backward while the operation unit body is fixed.

このように構成された医療用結紮装置により体腔内の病変部を結紮する場合には、内視鏡装置等を介して医療用結紮装置を体腔内に挿入し、病変部に結紮ワイヤを引っ掛ける。この状態で、操作部本体を固定してスライダを基端方向に移動させて操作ワイヤを後退させる。これにより、結紮ワイヤが第２部材の内部に引き込まれるので、該結紮ワイヤが縮径する。こうすることで、病変部が緊縛されて血流を止めることができる。そして、さらに、操作ワイヤを引っ張ることで、病変部が第２部材側に引っ張られるので、第２部材が、該病変部を介して第１部材側に押される。該第２部材の移動により、第１部材の圧入部が、固定用内腔内に相対的に移動する。従って、固定用内腔内の結紮ワイヤは、固定用内腔の内面と圧入部の外面との間に挟持されて固定される。また、結紮ワイヤは、挟持された基端側にて第１部材の切断刃によって切断される。更に、このとき、係合爪が係合孔内に嵌り、第１部材と第２部材とが互いに係合状態となる。
上述したように、病変部を緊縛後、該病変部を介して第２部材を第１部材に向けて移動させて両部材を係合させた時に、両部材間で結紮ワイヤを挟持して固体すると共に挟持位置後方で結紮ワイヤを切断して結紮処理を終了する。
特開２００３−２０４９６６号公報（段落番号００４６−００６１、第９−１４図） When a lesioned part in a body cavity is ligated by the medical ligation apparatus configured as described above, the medical ligation apparatus is inserted into the body cavity via an endoscope apparatus or the like, and a ligature wire is hooked on the lesioned part. In this state, the operation unit main body is fixed and the slider is moved in the proximal direction to retract the operation wire. As a result, the ligature wire is drawn into the second member, so that the diameter of the ligature wire is reduced. By doing so, the lesioned part is bound and blood flow can be stopped. Further, since the lesioned part is pulled toward the second member by pulling the operation wire, the second member is pushed toward the first member via the lesioned part. By the movement of the second member, the press-fitting portion of the first member relatively moves into the fixing lumen. Therefore, the ligating wire in the fixing lumen is clamped and fixed between the inner surface of the fixing lumen and the outer surface of the press-fitting portion. Further, the ligating wire is cut by the cutting blade of the first member on the clamped proximal end side. Further, at this time, the engaging claw is fitted into the engaging hole, and the first member and the second member are engaged with each other.
As described above, after binding the lesioned part, when the second member is moved toward the first member via the lesioned part and the both members are engaged, the ligation wire is sandwiched between the two members and the solid is At the same time, the ligation wire is cut behind the clamping position and the ligation process is terminated.
Japanese Unexamined Patent Publication No. 2003-204966 (paragraph numbers 0046-0061, FIGS. 9-14)

しかしながら上記特許文献１記載の医療用結紮装置では、第２部材を第１部材側に移動させて結紮ワイヤの挟持及び切断を行うときに、生体組織である病変部を介して第２の部材を移動させていた。この際、病変部が軟性である場合には、該病変部が所望する方向、即ち、第２部材を押す方向には移動せずに、所望する方向とは別の異なる方向に逃げてしまう可能性があった。また、病変部が軟性である場合、病変部が潰れてしまい第２の部材へ力が確実に伝えられない可能性があった。そのため、第２部材と第１部材とを嵌合させて結紮ワイヤの挟持及び切断操作を行うことが難しい場合があった。   However, in the medical ligation apparatus described in Patent Document 1, when the second member is moved to the first member side to clamp and cut the ligation wire, the second member is inserted through the lesioned part that is a living tissue. It was moved. In this case, if the lesioned part is soft, the lesioned part may escape in a direction different from the desired direction without moving in the direction desired by the lesioned part, that is, in the direction of pushing the second member. There was sex. Moreover, when the lesioned part is soft, the lesioned part may be crushed and the force may not be reliably transmitted to the second member. Therefore, it may be difficult to perform the pinching and cutting operation of the ligating wire by fitting the second member and the first member.

本発明は、このような事情を考慮してなされたものであって、その目的は、生体組織に対して所定処理後、結紮ワイヤ等の線材を生体組織を介さずに固定及び切断することができる医療用処置具を提供することである。   The present invention has been made in consideration of such circumstances, and its purpose is to fix and cut a wire material such as a ligature wire without passing through a living tissue after a predetermined treatment is performed on the living tissue. It is to provide a medical treatment tool that can be used.

上記目的を達成するために、本発明は、以下の手段を提供する。
請求項１に係る発明は、生体組織に対して所定処理を行う可撓性の線材と、該線材の進退操作を行う線材操作部と、前記線材に対して進退自在に設けられ、線材を保持する第１の線材保持部材と、該第１の線材保持部材の基端側に軸方向に進退自在に設けられ、第１の線材保持部材との間で前記線材を挟持可能な第２の線材保持部材と、該第２の線材保持部材の基端側に当接して設けられた可撓性を有する第１のシースと、該第１のシースを覆って第１のシースに対して進退自在に設けられた可撓性を有する第２のシースと、該第２のシースの進退操作を行うシース操作部とを備え、前記第１の線材保持部材及び前記第２のシースが、互いを接続させる接続手段を有し、前記第１の線材保持部材及び前記第２の線材保持部材が、前記線材を挟持したときに、互いを係止する係止手段及び線材を前記挟持位置よりも基端側で切断する切断手段を有し、前記第２の線材保持部材が、第１の線材保持部材に係止されたときに、前記接続手段の接続を解く接続解放手段を有する医療用処置具を提供する。 In order to achieve the above object, the present invention provides the following means .
The invention according to claim 1 is provided with a flexible wire material that performs a predetermined process on a living tissue, a wire material operation unit that performs an advance / retreat operation of the wire material, and a wire material that is movable forward and backward with respect to the wire material, and holds the wire material A first wire rod holding member and a second wire rod which is provided on the proximal end side of the first wire rod holding member so as to be capable of moving forward and backward in the axial direction and can hold the wire rod between the first wire rod holding member A holding member, a flexible first sheath provided in contact with the proximal end side of the second wire holding member, and the first sheath covering the first sheath can be moved forward and backward. A flexible second sheath, and a sheath operating portion for performing a forward and backward operation of the second sheath, wherein the first wire holding member and the second sheath are connected to each other. The first wire rod holding member and the second wire rod holding member sandwich the wire rod. The second wire rod holding member is locked to the first wire rod holding member, and the second wire rod holding member is locked to the first wire rod holding member. When it is done, a medical treatment instrument having a connection release means for disconnecting the connection means is provided.

この発明に係る医療用処置具においては、線材操作部により線材を進退操作して、該線材による生体組織への所定処理が終了した後、シース操作部を基端方向に移動して、第２のシースを第１のシースに対して後退させると、接続手段により接続された第１の線材保持部材が基端方向、即ち、第２の線材保持部材に向けて移動する。この際、第２の線材保持部材は、第１のシースの先端に当接しているので、基端方向に移動することはない。つまり、第１の線材保持部材と第２の線材保持部材とが確実に接近する。そして、シース操作部のさらなる操作によって、両部材を互いに接近させて両部材間で線材を挟持する。また、この際、係止手段によって線材を挟持した状態で両部材を互いに係止することができると共に、切断手段によって線材を挟持位置よりも基端側で切断することができる。
更に、両部材が係止したときに、接続解放手段が接続手段の接続を解くので、第１の線材保持部材と第２のシースとが切り離される。よって、シース操作部を介して第２のシースを後退操作すると、該第２シースから線材を挟持固定及び切断した状態で互いに係止された第１部材及び第２部材を切り離すことができる。 In the medical treatment tool according to the present invention, the wire rod is moved forward and backward by the wire rod operation portion, and after the predetermined processing to the living tissue by the wire rod is completed, the sheath operation portion is moved in the proximal direction, and the second When the sheath is retracted with respect to the first sheath, the first wire holding member connected by the connecting means moves in the proximal direction, that is, toward the second wire holding member. At this time, since the second wire holding member is in contact with the distal end of the first sheath, it does not move in the proximal direction. That is, the first wire holding member and the second wire holding member are reliably approached. And by further operation of a sheath operation part, both members are mutually approached and a wire is clamped between both members. At this time, both members can be locked with each other in a state where the wire is held by the locking means, and the wire can be cut at the base end side from the holding position by the cutting means.
Furthermore, when both members are locked, the connection release means disconnects the connection means, so that the first wire holding member and the second sheath are separated. Accordingly, when the second sheath is retracted through the sheath operating portion, the first member and the second member that are locked to each other in a state where the wire is sandwiched, fixed and cut from the second sheath can be separated.

このように、生体組織を介さずに、第１の線材保持部材を第２の線材保持部材の方向に移動させて、両部材間で所定処理終了後の線材を挟持して固定すると共に、挟持位置後方で線材を切断することができる。従って、生体組織の状態に係わらず、確実に線材の挟持固定及び切断を行うことができるので、操作性、作業性の正確性を向上することができる。また、第１の線材保持部材と第２の線材保持部材とを係止させることによる線材の挟持固定及び切断と、第１の線材保持部材と第２のシースとの接続解放とをシース操作部の一連の操作によって略同時に行うことができ、効率の良い作業を行うことができる。   In this way, the first wire holding member is moved in the direction of the second wire holding member without interposing the living tissue, and the wire after completion of the predetermined processing is sandwiched and fixed between the two members, and the nipping is performed. The wire can be cut behind the position. Therefore, since the wire can be securely clamped and cut regardless of the state of the living tissue, the operability and the accuracy of workability can be improved. In addition, the sheath operating portion includes: clamping and fixing of the wire by locking the first wire holding member and the second wire holding member; and connection release between the first wire holding member and the second sheath. Can be performed substantially simultaneously by a series of operations, and efficient work can be performed.

請求項２に係る発明は、請求項１に記載の医療用処置具において、前記切断手段が、前記第１の線材保持部材の内部にて前記線材を切断する医療用処置具を提供する。
この発明に係る医療用処置具においては、線材を切断するときに、切断手段が第１の線材保持部材の内部にて線材を切断するので、切断後の線材の切断端部が第１の線材保持部材の外部に露出することはない。従って、生体内において他の処置具等との干渉を防止することができる。 The invention according to claim 2 provides the medical treatment instrument according to claim 1 , wherein the cutting means cuts the wire inside the first wire holding member.
In the medical treatment instrument according to the present invention, when the wire is cut, the cutting means cuts the wire inside the first wire holding member, so that the cut end portion of the wire after cutting is the first wire. It is not exposed to the outside of the holding member. Accordingly, it is possible to prevent interference with other treatment tools and the like in the living body.

請求項３に係る発明は、生体組織に対して所定処理を行う可撓性の線材と、該線材の進退操作を行う線材操作部と、前記線材に対して進退自在に設けられ、線材を保持する第１の線材保持部材と、該第１の線材保持部材の基端側に軸方向に進退自在に設けられ、第１の線材保持部材との間で前記線材を挟持する第２の線材保持部材と、該第２の線材保持部材の基端側に当接して設けられた可撓性を有する第１のシースと、該第１のシースを覆って第１のシースに対して進退自在に設けられた可撓性を有する第２のシースと、該第２のシースの先端に設けられ、前記線材を前記挟持位置よりも基端側で切断する切断刃を前記線材より先端側に配する切断部材と、該第２のシースの進退操作を行うシース操作部とを備え、前記第１の線材保持部材及び前記第２のシースが、互いを接続させる接続手段を有し、前記第１の線材保持部材及び前記第２の線材保持部材が、前記線材を挟持したときに、互いを係止する係止手段を有し、前記第２の線材保持部材が、第１の線材保持部材に係止されたときに、前記接続手段の接続を解く接続解放手段を有する医療用処置具を提供する。 The invention according to claim 3 is provided with a flexible wire rod that performs a predetermined process on a biological tissue, a wire rod operation unit that performs an advance / retreat operation of the wire rod, and a wire rod that is freely movable forward and backward with respect to the wire rod. A first wire rod holding member, and a second wire rod holding member which is provided on the base end side of the first wire rod holding member so as to be movable forward and backward in the axial direction and sandwiches the wire rod with the first wire rod holding member. A member, a flexible first sheath provided in contact with the proximal end side of the second wire holding member, and the first sheath covering the first sheath so as to be movable back and forth with respect to the first sheath A flexible second sheath that is provided and a cutting blade that is provided at the distal end of the second sheath and that cuts the wire rod on the proximal side from the clamping position are arranged on the distal side from the wire rod. A first member for holding a wire, comprising: a cutting member; and a sheath operating portion that performs an advance / retreat operation of the second sheath. And the second sheath has a connection means for connecting each other, and the first wire holding member and the second wire holding member hold the wire together to lock each other. There is provided a medical treatment instrument having a connection releasing means for releasing the connection means when the second wire holding member is locked to the first wire holding member.

この発明に係る医療用処置具においては、線材操作部により線材を進退操作して、該線材による生体組織への所定処理が終了した後、シース操作部を基端方向に移動して、第２のシースを第１のシースに対して後退させると、接続手段により接続された第１の線材保持部材が基端方向、即ち、第２の線材保持部材に向けて移動する。この際、第２の線材保持部材は、第１のシースの先端に当接しているので、基端方向に移動することはない。つまり、第１の線材保持部材と第２の線材保持部材とが確実に接近する。また、第２のシースの先端に設けられている切断刃も、第１の線材保持部材と共に第２の線材保持部材側に移動する。そして、シース操作部のさらなる操作によって、両線材保持部材を互いに接近させて両線材保持部材間で線材を挟持する。また、この際、係止手段によって線材を挟持した状態で両線材保持部材を互いに係止することができる。なお、このとき、切断刃と第１の線材保持部材との相対位置は変化しないので、切断刃によって線材が切断されない。
更に、両線材保持部材が係止したときに、接続解放手段が接続手段の接続を解くので、第１の線材保持部材と第２のシースとが切り離される。これにより、さらなるシース操作部の後退操作によって、切断刃が基端方向に移動して挟持位置よりも基端側で線材の切断を行う。 In the medical treatment tool according to the present invention, the wire rod is moved forward and backward by the wire rod operation portion, and after the predetermined processing to the living tissue by the wire rod is completed, the sheath operation portion is moved in the proximal direction, and the second When the sheath is retracted with respect to the first sheath, the first wire holding member connected by the connecting means moves in the proximal direction, that is, toward the second wire holding member. At this time, since the second wire holding member is in contact with the distal end of the first sheath, it does not move in the proximal direction. That is, the first wire holding member and the second wire holding member are reliably approached. The cutting blade provided at the tip of the second sheath also moves to the second wire holding member side together with the first wire holding member. Then, by further operation of the sheath operating portion, the two wire holding members are brought close to each other and the wire is held between the two wire holding members. At this time, the two wire holding members can be locked to each other with the wire held by the locking means. At this time, since the relative position between the cutting blade and the first wire holding member does not change, the wire is not cut by the cutting blade.
Further, when both the wire holding members are locked, the connection release means disconnects the connection means, so that the first wire holding member and the second sheath are separated. Accordingly, the cutting blade moves in the proximal direction by further retreating the sheath operation portion, and the wire is cut on the proximal side with respect to the holding position.

このように、生体組織を介さずに、第１の線材保持部材を第２の線材保持部材の方向に移動させて、両線材保持部材間で所定処理終了後の線材を挟持して固定すると共に、挟持位置後方で線材を切断することができる。従って、生体組織の状態に係わらず、確実に線材の挟持固定及び切断を行うことができるので、操作性、作業の正確性を向上することができる。
また、第１の線材保持部材と第２の線材保持部材とを係止させることによる線材の挟持固定と、第１の線材保持部材と第２のシースとの接続解放と、該接続解放による線材の切断とをシース操作部の一連の操作によって略同時に行うことができ、効率の良い作業を行うことができる。特に、線材の挟持固定を行った後に、該線材の切断を行えるので、両動作をそれぞれ確実に実施することができる。従って、作業の確実性をより向上することができる。 In this way, the first wire holding member is moved in the direction of the second wire holding member without interposing the living tissue, and the wire after completion of the predetermined processing is sandwiched and fixed between the two wire holding members. The wire can be cut behind the clamping position. Therefore, since the wire can be securely clamped and cut regardless of the state of the living tissue, the operability and work accuracy can be improved.
Further, the wire rod is clamped and fixed by locking the first wire rod holding member and the second wire rod holding member, the connection between the first wire rod holding member and the second sheath is released, and the wire rod by the connection release. Can be performed substantially simultaneously by a series of operations of the sheath operating portion, and an efficient operation can be performed. In particular, since the wire can be cut after the wire is clamped and fixed, both operations can be performed reliably. Therefore, the certainty of work can be further improved.

請求項４に係る発明は、請求項３に記載の医療用処置具において、前記第２の線材保持部材が、切断後の前記線材の切断端部を内部に収納する線材収納部を有する医療用処置具を提供する。
この発明に係る医療用処置具においては、第２の線材保持部材が、切断後の線材の切断端部を線材収納部に収納するので、切断端部が第２の線材保持部材の外部に露出することはない。従って、生体内において他の処置具等との干渉を防止することができる。 According to a fourth aspect of the present invention, in the medical treatment instrument according to the third aspect , the second wire rod holding member has a wire rod storage portion that stores therein the cut end portion of the wire rod after cutting. Providing a treatment tool.
In the medical treatment instrument according to the present invention, the second wire holding member stores the cut end of the cut wire in the wire storage, so that the cut end is exposed to the outside of the second wire holding member. Never do. Accordingly, it is possible to prevent interference with other treatment tools and the like in the living body.

請求項５に係る発明は、請求項３又は４に記載の医療用処置具において、前記切断部材が、前記第２のシースに着脱可能に設けられている医療用処置具を提供する。
この発明に係る医療用処置具においては、切断部材を第２のシースから着脱させて交換することができる。従って、切断刃を新品状態にでき、切断性を維持することができる。 The invention according to claim 5 provides the medical treatment instrument according to claim 3 or 4 , wherein the cutting member is detachably provided on the second sheath.
In the medical treatment tool according to the present invention, the cutting member can be detached from the second sheath and exchanged. Therefore, the cutting blade can be brought into a new state, and the cutting performance can be maintained.

請求項６に係る発明は、請求項１から５のいずれか１項に記載の医療用処置具において、前記接続手段が、前記第２のシースから先端方向に突出すると共に先端に第２のシースの内部に向けて突起した爪部を有する突出部と、前記第１の接続部材の外周に設けられて前記爪部に係止可能な係止孔とからなり、前記接続解放手段が、前記係止状態のときに、前記係止孔内に嵌合すると共に前記爪部を係止孔から押し出し可能な係合爪である医療用処置具を提供する。 According to a sixth aspect of the present invention, in the medical treatment instrument according to any one of the first to fifth aspects, the connecting means protrudes from the second sheath in the distal direction and has a second sheath at the distal end. A protrusion having a claw protruding toward the inside of the first connection member, and a locking hole provided on an outer periphery of the first connection member and engageable with the claw, wherein the connection release means is the engagement member. Provided is a medical treatment instrument that is an engaging claw that fits into the locking hole and can push out the claw portion from the locking hole in a stopped state.

この発明に係る医療用処置具においては、突出部の爪部が係止孔内に嵌って係止することで、第１の線材保持部材と第２のシースとが互いに接続される。また、第１の線材保持部と第２の線材保持部材との間で線材を挟持したときに、第２の接続部材部材の係合爪が係止孔内に嵌合すると共に、上記爪部を係止孔内から押しだす。これにより、第１の線材部材と第２のシースとの接続を確実に解くことができる。   In the medical treatment tool according to the present invention, the first wire holding member and the second sheath are connected to each other by the nail portion of the protruding portion fitted and locked in the locking hole. In addition, when the wire rod is sandwiched between the first wire rod holding portion and the second wire rod holding member, the engaging claws of the second connecting member member are fitted in the locking holes, and the claw portion Is pushed out of the locking hole. Thereby, the connection between the first wire member and the second sheath can be reliably released.

請求項７に係る発明は、請求項６に記載の医療用処置具において、前記係止手段が、前記係止孔と前記係合爪とからなる医療用処置具を提供する。
この発明に係る医療用処置具においては、第１の線材保持部材と第２の線材保持部材とが、線材を挟持したときに、係合爪が係止孔内に嵌ることで、両部材の係止が行える。このように、接続手段の係止孔と、接続解放手段である係合爪とを利用することで、両部材の係止が確実に行えるので、係止手段を別個に設ける必要がない。従って、構成の容易化を図ることができる。 The invention according to claim 7 provides the medical treatment instrument according to claim 6 , wherein the locking means includes the locking hole and the engaging claw.
In the medical treatment instrument according to the present invention, when the first wire holding member and the second wire holding member sandwich the wire, the engaging claws are fitted in the locking holes, so that both members Can be locked. As described above, since the locking holes of the connecting means and the engaging claws as the connection releasing means are used, both the members can be reliably locked, so that it is not necessary to provide the locking means separately. Therefore, simplification of the configuration can be achieved.

請求項８に係る発明は、請求項１から７のいずれか１項に記載の医療用処置具において、前記線材が、生体組織を結紮する結紮ワイヤである医療用処置具を提供する。
この発明に係る医療用処置具においては、結紮ワイヤを体内の生体組織に引っ掛けた後、線材操作部を基端方向に操作することで、生体組織の結紮が行える。そして、結紮した後、該生体組織の状態に関係なく、第１の線材保持部材と第２の線材保持部材との間で結紮ワイヤを挟持固定及び切断を確実に行うことができる。 The invention according to claim 8 provides the medical treatment instrument according to any one of claims 1 to 7 , wherein the wire is a ligature wire for ligating a living tissue.
In the medical treatment instrument according to the present invention, the biological tissue can be ligated by hooking the ligating wire to the biological tissue in the body and then operating the wire operation portion in the proximal direction. And after ligating, regardless of the state of the living tissue, the ligation wire can be securely clamped and cut between the first wire holding member and the second wire holding member.

請求項９に係る発明は、請求項１から７のいずれか１項に記載の医療用処置具において、前記線材が、生体組織を縫合する縫合糸であり、該縫合糸の先端に接続された抜止部材と、該抜止部材を着脱自在に収納すると共に、先端に生体組織に穿刺する針部を有する縫合針本体とを備える医療用処置具を提供する。
この発明に係る医療用処置具においては、体内の生体組織に対して針部で穿刺しながら縫合針本体を操作して、該生体組織を縫合する。縫合後、抜止部材を縫合針本体から離脱させると共に、線材操作部を基端方向に操作することで、抜止部材と第１の線材保持部材との間に生体組織を引き寄せる。そして、この状態で、生体組織の状態に関係なく、第１の線材保持部材と第２の線材保持部材との間で縫合糸の挟持固定及び切断を確実に行うことができる。 The invention according to claim 9 is the medical treatment instrument according to any one of claims 1 to 7 , wherein the wire is a suture for suturing a living tissue, and is connected to a distal end of the suture. Provided is a medical treatment instrument that includes a retaining member and a suture needle main body having a needle portion that punctures a living tissue at a distal end while detachably housing the retaining member.
In the medical treatment tool according to the present invention, the living tissue is sutured by operating the suture needle body while puncturing the living tissue in the body with the needle portion. After the suturing, the retaining member is detached from the suture needle body, and the living tissue is pulled between the retaining member and the first wire holding member by operating the wire operation portion in the proximal direction. In this state, the suture can be securely clamped and cut between the first wire holding member and the second wire holding member regardless of the state of the living tissue.

この発明に係る医療用処置具によれば、生体組織を介さずに、第１の線材保持部材を第２の線材保持部材の方向に移動させて、両部材間で所定処理終了後の線材を挟持固定すると共に挟持位置後方で線材の切断を行うことができる。つまり、生体組織の状態に係わらず、確実に線材の挟持固定及び切断を行うことができるので、操作性、作業の正確性を向上することができる。
また、第１の線材保持部材と第２の線材保持部材とを係止させることによる線材の挟持固定及び切断と、第１の線材保持部材と第２のシースとの接続解放とをシース操作部の一連の操作によって略同時に行うことができ、効率の良い作業を行うことができる。 According to the medical treatment instrument of the present invention, the first wire holding member is moved in the direction of the second wire holding member without passing through the living tissue, and the wire after the predetermined processing is finished between the two members. The wire rod can be cut at the rear of the clamping position while being clamped and fixed. That is, since the wire can be securely clamped and cut regardless of the state of the living tissue, operability and work accuracy can be improved.
In addition, the sheath operating portion includes: clamping and fixing of the wire by locking the first wire holding member and the second wire holding member; and connection release between the first wire holding member and the second sheath. Can be performed substantially simultaneously by a series of operations, and efficient work can be performed.

本発明に係る医療用処置具の第１実施形態について、図１から図１８を参照して説明する。本実施形態の医療用処置具１は、図１に示すように、内視鏡システム２の構成品である内視鏡装置３の処置具チャンネル４内に挿通されて、体内の生体組織に対して所定処理を行うものである。なお、本実施形態においては、医療用処置具１は、生体組織を結紮する結紮装置として説明する。また、上記内視鏡システム２は、上記内視鏡装置３によって撮像された画像の表示、記録等を行なう内視鏡ユニット５を備えている。   1st Embodiment of the medical treatment tool which concerns on this invention is described with reference to FIGS. As shown in FIG. 1, the medical treatment instrument 1 of the present embodiment is inserted into a treatment instrument channel 4 of an endoscopic device 3 that is a component of the endoscope system 2, and is applied to a living tissue in the body. Predetermined processing. In the present embodiment, the medical treatment tool 1 will be described as a ligation apparatus that ligates living tissue. In addition, the endoscope system 2 includes an endoscope unit 5 that displays, records, and the like of an image captured by the endoscope apparatus 3.

上記内視鏡装置３は、図１及び図２に示すように、体内に挿入されるフレキシブルに湾曲可能な長尺な内視鏡挿入部１０と、該内視鏡挿入部１０の基端に接続された操作部１１とを備えている。内視鏡挿入部１０の先端は、任意に角度変更自在な湾曲部１２が接続されており、該湾曲部１２の先端に体内を観察する観察用撮像部１３と、上記内視鏡ユニット５から供給された照明光を体内に照射する照射部１４とを有している。また、上記処置具チャンネル４は、操作部１１の近傍に設けられた処置具挿通孔１５から内視鏡挿入部１０の先端まで貫通するように該内視鏡挿入部１０内に長さ方向に沿って形成されている。   As shown in FIG. 1 and FIG. 2, the endoscope apparatus 3 includes a long and flexible endoscope insertion portion 10 that can be flexibly inserted and a proximal end of the endoscope insertion portion 10. And a connected operation unit 11. The distal end of the endoscope insertion portion 10 is connected to a bending portion 12 that can freely change the angle. The observation imaging portion 13 for observing the inside of the body is connected to the distal end of the bending portion 12 and the endoscope unit 5. And an irradiation unit 14 that irradiates the body with the supplied illumination light. The treatment instrument channel 4 extends in the length direction in the endoscope insertion section 10 so as to penetrate from the treatment instrument insertion hole 15 provided in the vicinity of the operation section 11 to the distal end of the endoscope insertion section 10. Are formed along.

上記観察用撮像部１３は、図２に示すように、内視鏡挿入部１０の先端、即ち、湾曲部１２の先端に配された対物レンズ等の観察用光学系１６と、該観察用光学系１６の結像位置に配された個体撮像素子である内視鏡ＣＣＤ１７とから構成されている。また、内視鏡ＣＣＤ１７に接続されたケーブル１８は、内視鏡挿入部１０内を通って操作部１１の後端まで引き出され、上記内視鏡ユニット５に接続されている。
上記照射部１４は、内視鏡挿入部１０の先端、即ち、湾曲部１２の先端に配された照明レンズ２０と、上記内視鏡ユニット５から供給された照明光を照明レンズ２０まで導く光ファイバの束であるＬＧファイババンドル２１とを有している。 As shown in FIG. 2, the observation imaging unit 13 includes an observation optical system 16 such as an objective lens disposed at the distal end of the endoscope insertion unit 10, that is, the distal end of the bending unit 12, and the observation optical unit. It is composed of an endoscope CCD 17 which is an individual imaging device arranged at an image forming position of the system 16. Further, the cable 18 connected to the endoscope CCD 17 is pulled out to the rear end of the operation unit 11 through the endoscope insertion unit 10 and is connected to the endoscope unit 5.
The irradiation unit 14 is a light that guides the illumination light supplied from the endoscope unit 5 to the illumination lens 20 disposed at the distal end of the endoscope insertion unit 10, that is, the distal end of the bending unit 12. And an LG fiber bundle 21 which is a bundle of fibers.

上記操作部１１は、図１に示すように、複数のスイッチ２５と、操作ノブ２６とを備えている。スイッチ２５は、所望の機能を設定可能なプログラマブルなスイッチであり、例えば、そのうちの１つは、内視鏡ＣＣＤ１７により撮像されている内視鏡画像を記録する際に押下されるスイッチとして機能するようになっている。このスイッチ２５の信号は、ケーブル２７を介して上記内視鏡ユニット５に送られるようになっている。
上記操作ノブ２６は、上記湾曲部１２を任意の方向に湾曲させて、先端に配されている対物レンズ１６、照明レンズ１４及び処置具チャンネル４の出口の向き等の方向をコントロールできるようになっている。これにより、体内を任意の角度から観察することができるようになっている。 As shown in FIG. 1, the operation unit 11 includes a plurality of switches 25 and an operation knob 26. The switch 25 is a programmable switch capable of setting a desired function. For example, one of the switches 25 functions as a switch that is pressed when recording an endoscopic image captured by the endoscope CCD 17. It is like that. A signal from the switch 25 is sent to the endoscope unit 5 through a cable 27.
The operation knob 26 bends the bending portion 12 in an arbitrary direction, and can control directions such as the orientation of the objective lens 16, the illumination lens 14, and the exit of the treatment instrument channel 4 disposed at the distal end. ing. Thereby, the inside of the body can be observed from an arbitrary angle.

上記内視鏡ユニット５は、照明レンズ２０に照明光を供給する光源装置３０と、内視鏡ＣＣＤ１７に接続されたケーブル１８の後端に接続され、内視鏡ＣＣＤ１７により撮像された撮像信号を処理するプロセッサ３１と、該プロセッサ３１に接続され、該プロセッサ３１から出力された映像信号を記録する記録装置３２とを有している。
上記光源装置３０は、例えば、白色光を発生するランプ３３と、該ランプ３３から発生された白色光を面順次式に変換する赤、青、緑の色透過フィルタを取り付けた回転フィルタ３４と、面順次光を集光してＬＧファイババンドル２１に入射する集光レンズ３５とを有している。なお、ランプ３３は、操作部１１に配されているスイッチ２５の１つにより作動が制御されている。 The endoscope unit 5 is connected to the light source device 30 that supplies illumination light to the illumination lens 20 and the rear end of the cable 18 connected to the endoscope CCD 17, and captures an image signal captured by the endoscope CCD 17. A processor 31 for processing and a recording device 32 connected to the processor 31 for recording a video signal output from the processor 31 are provided.
The light source device 30 includes, for example, a lamp 33 that generates white light, and a rotary filter 34 to which red, blue, and green color transmission filters that convert the white light generated from the lamp 33 into a field sequential type are attached; And a condensing lens 35 that condenses the surface sequential light and enters the LG fiber bundle 21. The operation of the lamp 33 is controlled by one of the switches 25 arranged in the operation unit 11.

上記プロセッサ３１は、内視鏡ＣＣＤ１７を駆動するＣＣＤドライブ回路３６と、内視鏡ＣＣＤ１７から出力される撮像信号に対して信号処理を行い映像信号を生成する映像処理回路３７とを有している。また、プロセッサ３１は、ケーブル３８を介して上記ケーブル２７に接続されており、ＣＣＤドライブ回路３６からのＣＣＤ駆動信号が内視鏡ＣＣＤ１７に送られると共に、内視鏡ＣＣＤ１７からの撮像信号が映像処理回路３７に送られるようになっている。また、プロセッサ３１は、両ケーブル３８、２７を介して送られるスイッチ２５の信号に基づいて、ハードディスク等の上記記録装置３２及びディスプレイ等のモニタ３９に映像信号を出力するようになっている。更に、プロセッサ３１には、キーボード等の入力手段４０が接続されており、内視鏡ＣＣＤ１７により撮像された映像に、被検者の氏名、ＩＤ番号、診断情報等の様々な情報を付加できるようになっている。   The processor 31 includes a CCD drive circuit 36 that drives the endoscope CCD 17 and a video processing circuit 37 that performs signal processing on an imaging signal output from the endoscope CCD 17 to generate a video signal. . The processor 31 is connected to the cable 27 via the cable 38, and the CCD drive signal from the CCD drive circuit 36 is sent to the endoscope CCD 17, and the image pickup signal from the endoscope CCD 17 is subjected to video processing. It is sent to the circuit 37. The processor 31 outputs a video signal to the recording device 32 such as a hard disk and a monitor 39 such as a display on the basis of the signal of the switch 25 sent via both cables 38 and 27. Furthermore, the processor 31 is connected to an input means 40 such as a keyboard so that various information such as the name, ID number, and diagnostic information of the subject can be added to the image captured by the endoscope CCD 17. It has become.

上記医療用処置具１は、図３及び図４に示すように、生体組織に対して所定処理、即ち、結紮を行う可撓性の結紮ワイヤ（線材）５０と、該結紮ワイヤ５０の進退操作を行う線材操作部５１と、結紮ワイヤ５０に対して進退自在に設けられて該結紮ワイヤ５０を保持する第１部材（第１の線材保持部材）５２と、該第１部材５２の基端側に軸方向に進退自在に設けられて第１部材５２との間で結紮ワイヤ５０を挟持可能な第２部材（第２の線材保持部材）５３と、該第２部材５３の基端側に当接して設けられた可撓性を有する内側シース（第１のシース）５４と、該内側シース５４を覆って該内側シース５４に対して進退自在に設けられた可撓性を有する嵌合シース（第２のシース）５５と、該嵌合シース５５の進退操作を行う嵌合グリップ（シース操作部）５６とを備えている。   As shown in FIGS. 3 and 4, the medical treatment instrument 1 includes a flexible ligation wire (wire) 50 that performs a predetermined process, that is, ligation, on a living tissue, and an advance / retreat operation of the ligation wire 50. , A first member (first wire holding member) 52 that is provided so as to be able to advance and retreat with respect to the ligation wire 50 and holds the ligation wire 50, and a base end side of the first member 52 A second member (second wire holding member) 53 that is provided so as to be movable forward and backward in the axial direction and can hold the ligating wire 50 between the first member 52 and a proximal end side of the second member 53. A flexible inner sheath (first sheath) 54 provided in contact therewith, and a flexible fitting sheath (covering the inner sheath 54 so as to be able to advance and retreat with respect to the inner sheath 54) (Second sheath) 55 and a fitting grip for performing a forward and backward operation of the fitting sheath 55 And a sheath operating section) 56.

また、上記第１部材５２及び上記内側シース５４は、互いを接続させる接続手段５７を有している。また、第１部材５２及び第２部材５３は、結紮ワイヤ５０を挟持したときに、互いを係止する係止手段５８、及び結紮ワイヤ５０を挟持位置よりも基端側で切断する切断手段５９とを有している。さらに、上記第２部材５３は、第１部材５２に係止されたときに、上記接続手段５７の接続を解く係合爪（接続解放手段）６０を有している。これらについては、後に詳細に説明する。   The first member 52 and the inner sheath 54 have connecting means 57 for connecting each other. Further, the first member 52 and the second member 53 include a locking unit 58 that locks the ligation wire 50 when the ligation wire 50 is clamped, and a cutting unit 59 that cuts the ligation wire 50 on the proximal side from the clamping position. And have. Further, the second member 53 has an engaging claw (connection release means) 60 for releasing the connection of the connection means 57 when the second member 53 is locked to the first member 52. These will be described in detail later.

また、本実施形態の医療用処置具１は、生体内に留置される医療用結紮具６１と、該医療用結紮具６１を体内に誘導して結紮操作を行う操作装置６２とから構成されている。また、操作装置６２は、上記処置具チャンネル４内に挿通される可撓性を有する挿入部６３と、手元操作部６４とから構成されている。
上記挿入部６３は、例えば、ポリエチレン、ＰＴＦＥ等の可撓性を有するプラスチックにより形成された外側シース６５と、該外側シース６５の内側に進退自在に挿通された上記嵌合シース５５と、該嵌合シース５５の内側に配された上記内側シース５４と、該内側シース５４の内側に進退自在に挿通され、ステンレス等の金属撚り線で形成された操作ワイヤ６６とから構成されている。
また、上記内側シース５４及び上記嵌合シース５５は、上記外側シース６５と同様に、例えば、ポリエチレン、ＰＴＦＥ等の可撓性を有するプラスチックで形成しても良いし、金属製メッシュが入っていても構わないし、金属製のコイルシースでも構わない。 The medical treatment instrument 1 according to the present embodiment includes a medical ligation instrument 61 placed in a living body, and an operation device 62 that guides the medical ligation instrument 61 into the body and performs a ligation operation. Yes. The operation device 62 includes a flexible insertion portion 63 inserted into the treatment instrument channel 4 and a hand operation portion 64.
The insertion portion 63 includes, for example, an outer sheath 65 formed of a flexible plastic such as polyethylene and PTFE, the fitting sheath 55 inserted through the outer sheath 65 so as to freely advance and retract, and the fitting The inner sheath 54 is arranged on the inner side of the combined sheath 55, and the operation wire 66 is inserted into the inner sheath 54 so as to be able to advance and retreat, and is formed of a metal strand such as stainless steel.
Further, the inner sheath 54 and the fitting sheath 55 may be formed of a flexible plastic such as polyethylene or PTFE, and contain a metal mesh, like the outer sheath 65. Alternatively, a metal coil sheath may be used.

上記手元操作部６４は、上記内側シース５４の基端側に接続された操作部本体７０と、上記操作ワイヤ６６の基端側に接続されると共に、操作部本体７０を覆って該操作部本体７０に対して進退自在なスライダ７１と、上記嵌合グリップ５６と、上記外側シース６５の基端側に接続されて外側シース６５の進退操作を行うグリップ７２とから構成されている。
上記操作部本体７０の基端側には、指かけリング７３が形成されている。また、上記スライダ７１は、中央部が両端より窪んだ形状とされている。これにより、例えば、指かけリング７３に親指を入れ、スライダ７１を人指し指、中指で挟むことによって、片手でスライダ７１を進退操作できるようになっている。 The hand operation unit 64 is connected to the operation unit main body 70 connected to the proximal end side of the inner sheath 54 and the proximal end side of the operation wire 66, and covers the operation unit main body 70 to cover the operation unit main body 70. The slider 71 is movable forward and backward with respect to 70, the fitting grip 56, and a grip 72 that is connected to the proximal end side of the outer sheath 65 and moves the outer sheath 65 forward and backward.
A finger ring 73 is formed on the proximal end side of the operation unit main body 70. The slider 71 has a shape in which the central portion is recessed from both ends. Thus, for example, the slider 71 can be moved forward and backward with one hand by putting a thumb in the finger ring 73 and pinching the slider 71 between the index finger and the middle finger.

上記嵌合グリップ５６は、上記操作部本体７０より先端側に配されており、基端方向に向けて操作したときに、操作部本体７０の先端に当接して、それ以上基端方向に移動しないようになっている。また、上記グリップ７２は、嵌合グリップ５６より先端側に配されている。これらグリップ７２、嵌合グリップ５６及びスライダ７１を進退操作することによって、外側シース６５、嵌合シース５５、内側シース５４及び操作ワイヤ６６を相対的に操作できるようになっている。   The fitting grip 56 is arranged on the distal end side with respect to the operation portion main body 70 and, when operated in the proximal direction, abuts on the distal end of the operation portion main body 70 and further moves in the proximal direction. It is supposed not to. Further, the grip 72 is arranged on the distal end side with respect to the fitting grip 56. By operating the grip 72, the fitting grip 56, and the slider 71 forward and backward, the outer sheath 65, the fitting sheath 55, the inner sheath 54, and the operation wire 66 can be relatively operated.

また、上記操作ワイヤ６６の先端には、フック形状の係合部材６６ａが固着されている。また、上記嵌合シース５５の先端には、図４から図６に示すように、該嵌合シース５５と同一の外径及び内径に形成されたステンレス等の金属部材からなる連結パイプ７５が接続されている。また、該連結パイプ７５には、嵌合シース５５の先端方向に突出すると共に先端に嵌合シース５５の内部に向けて突起した爪部７６ａを有する一対の連結フック（突出部）７６が接続されている。該一対の連結フック７６は、弾性を有する金属やプラスチック等で形成されており、互いに対向するように配されている。なお、連結フック７６は、連結パイプ７５内の溝部７５ａに埋没するように取り付けられており、連結パイプ７５の外表面に段差が生じないようになっている。   A hook-shaped engaging member 66 a is fixed to the tip of the operation wire 66. Further, as shown in FIGS. 4 to 6, a connecting pipe 75 made of a metal member such as stainless steel having the same outer diameter and inner diameter as the fitting sheath 55 is connected to the distal end of the fitting sheath 55. Has been. Also, a pair of connecting hooks (protruding portions) 76 that project in the distal direction of the fitting sheath 55 and have claw portions 76 a protruding toward the inside of the fitting sheath 55 are connected to the connecting pipe 75. ing. The pair of connecting hooks 76 are made of elastic metal, plastic, or the like, and are arranged to face each other. The connecting hook 76 is attached so as to be buried in the groove 75 a in the connecting pipe 75, so that no step is generated on the outer surface of the connecting pipe 75.

上記医療用結紮具６１は、図３から図５及び図７から図１４に示すように、上記結紮ワイヤ５０と、上記第１部材５２と、上記第２部材５３とを備えている。
上記結紮ワイヤ５０は、例えば、ナイロンや、ポリオレフィン等の合成樹脂、絹糸、生体吸収性の糸であり、先端側がループ部５０ａとなっている。なお、結紮ワイヤ５０は、単線、撚り線、網線のいずれの形態であっても構わない。また、結紮ワイヤ５０の基端側は、上記係合部材６６ａに係合可能な折り返し部５０ｂが形成されており、結紮ワイヤ５０の両端末及び平行する２本のワイヤは固定具としての接続パイプ７７によって接着や圧着等によって固定されている。
これにより、スライダ７１を進退操作することにより、操作ワイヤ６６及び係合部材６６ａを介して結紮ワイヤ５０の進退操作ができるようになっている。即ち、これらスライダ７１、操作ワイヤ６６及び係合部材６６ａは、上記線材操作部５１を構成している。 As shown in FIGS. 3 to 5 and FIGS. 7 to 14, the medical ligation tool 61 includes the ligation wire 50, the first member 52, and the second member 53.
The ligature wire 50 is, for example, a synthetic resin such as nylon or polyolefin, silk thread, or bioabsorbable thread, and the tip side is a loop portion 50a. The ligating wire 50 may be in any form of a single wire, a stranded wire, and a mesh wire. Further, a folded portion 50b that can be engaged with the engaging member 66a is formed on the proximal end side of the ligating wire 50, and both ends of the ligating wire 50 and the two parallel wires are a connection pipe as a fixture. 77 is fixed by adhesion or pressure bonding.
Thus, by moving the slider 71 forward and backward, the ligature wire 50 can be advanced and retracted via the operation wire 66 and the engaging member 66a. That is, the slider 71, the operation wire 66, and the engagement member 66a constitute the wire operation unit 51.

上記第１部材５２は、ポリプロピレン、ＡＢＳ，ポリアセタール、ポリカーボネイト等のプラスチックにより断面略楕円状の円筒状に形成されている。なお、第１部材５２は、前述したプラスチック又は液晶ポリマー、ポリフタルアミド等の比較的剛性があり、流動性に優れた材質が好ましいが、ステンレス、アルミニウム等の金属でも構わない。
この第１部材５２は、先端側に円柱部８０が設けられ、基端側に該円柱部８０に一体成型された円筒部８１が設けられている。また、第１部材５２の中心には、先端側から基端側に向けて断面略楕円状の挿入軸８２が突設されている。また、円柱部８０内には、該挿入軸８２を囲撓するように、上記第２部材５３の後述する圧入部９０が圧入される固定用内腔８４が設けられている。なお、固定用内腔８４の長さは、１〜３ｍｍが適当である。更に、固定用内腔８４の先端部には、圧入部９０の突き当て部８５が形成されており、また、固定用内腔８４の基端側端面には、上記第２部材５３の後述する切断刃９５の突き当て面８６が形成されている。 The first member 52 is formed in a cylindrical shape having a substantially elliptical cross section by a plastic such as polypropylene, ABS, polyacetal, or polycarbonate. The first member 52 is preferably made of a material that is relatively rigid and excellent in fluidity, such as the above-described plastic, liquid crystal polymer, or polyphthalamide, but may be a metal such as stainless steel or aluminum.
The first member 52 is provided with a cylindrical portion 80 on the distal end side and a cylindrical portion 81 integrally formed with the cylindrical portion 80 on the proximal end side. In addition, an insertion shaft 82 having a substantially elliptical cross section is provided projecting from the distal end side toward the proximal end side at the center of the first member 52. Further, in the cylindrical portion 80, a fixing lumen 84 into which a press-fit portion 90 described later of the second member 53 is press-fitted is provided so as to surround the insertion shaft 82. The length of the fixing lumen 84 is suitably 1 to 3 mm. Further, an abutting portion 85 of the press-fitting portion 90 is formed at the distal end portion of the fixing lumen 84, and the second member 53 will be described later on the proximal end surface of the fixing lumen 84. An abutting surface 86 of the cutting blade 95 is formed.

また、第１部材５２の先端面には、結紮ワイヤ５０を１本ずつ挿通する先端孔８７が形成されており、該先端孔８７より、結紮ワイヤ５０を上記固定用内腔８４内に挿通できるようになっている。また、円筒部８１の外周には、固定用内腔８４内に挿通された結紮ワイヤ５０を第１部材５２の外部に導く一対の側孔８８が形成されている。更に、円筒部８１の外周には、側孔８８から軸線を中心に周方向に９０度偏倚した位置に、上記連結フック７６の爪部７６ａに係止可能な一対の係止孔８９が形成されている。
即ち、該係止孔８９及び上記連結フック７６は、上記接続手段５７を構成している。 Further, a distal end hole 87 through which the ligating wire 50 is inserted one by one is formed on the distal end surface of the first member 52, and the ligating wire 50 can be inserted into the fixing lumen 84 from the distal end hole 87. It is like that. In addition, a pair of side holes 88 that guide the ligating wire 50 inserted into the fixing lumen 84 to the outside of the first member 52 are formed on the outer periphery of the cylindrical portion 81. Further, on the outer periphery of the cylindrical portion 81, a pair of locking holes 89 that can be locked to the claw portions 76a of the connecting hook 76 are formed at positions offset from the side holes 88 by 90 degrees in the circumferential direction around the axis. ing.
That is, the locking hole 89 and the connecting hook 76 constitute the connecting means 57.

上記第２部材５３は、第１部材５２と同様の材質により形成され、断面略楕円状の円筒状に形成されている。この第２部材５３は、先端側に小径部となる圧入部９０が設けられ、基端側に大径部９１が設けられている。また、第２部材５３の中心には、軸方向に向けて上記挿入軸８２を挿通可能な内腔９２が設けられている。これにより、上述したように、第２部材５３は、第１部材５２に対して軸方向に進退できるようになっている。なお、内腔９２の軸方向の略中間部には、挿入軸８２が容易に基端方向に向けて移動しないように突起９３が設けられている。なお、この突起９３の高さは、０．１ｍｍ〜０．３ｍｍが適当である。   The second member 53 is formed of the same material as that of the first member 52, and is formed in a cylindrical shape having a substantially elliptical cross section. The second member 53 is provided with a press-fit portion 90 that is a small-diameter portion on the distal end side and a large-diameter portion 91 on the proximal end side. Further, a lumen 92 through which the insertion shaft 82 can be inserted in the axial direction is provided at the center of the second member 53. Thereby, as described above, the second member 53 can move forward and backward in the axial direction with respect to the first member 52. In addition, a projection 93 is provided at a substantially intermediate portion in the axial direction of the lumen 92 so that the insertion shaft 82 does not easily move in the proximal direction. The height of the protrusion 93 is suitably 0.1 mm to 0.3 mm.

上記圧入部９０は、上記固定用内腔８４内に圧入されたときに、該固定用内腔８４内で前記結紮ワイヤ５０を挟持できるように、外径の大きさが設定されている。即ち、図１１に示す固定用内腔８４の内径と圧入部９０の外径との片側クリアランスＬが、結紮ワイヤ５０の外径よりも小さくなるように、圧入部９０の外径が設定されている。なお、このクリアランスＬは、圧入部９０の外径で設定するのではなく、固定用内径８４の内径により調整しても構わない。このように、圧入部９０及び固定用内径８４によって、第１部材５２と第２部材５３との間で結紮ワイヤ５０を挟持できるようになっている。   The press-fitting portion 90 is set to have an outer diameter so that the ligation wire 50 can be clamped in the fixing lumen 84 when it is press-fitted into the fixing lumen 84. That is, the outer diameter of the press-fit portion 90 is set so that the one-side clearance L between the inner diameter of the fixing lumen 84 and the outer diameter of the press-fit portion 90 shown in FIG. Yes. The clearance L may not be set by the outer diameter of the press-fit portion 90, but may be adjusted by the inner diameter of the fixing inner diameter 84. As described above, the ligation wire 50 can be held between the first member 52 and the second member 53 by the press-fitting portion 90 and the fixing inner diameter 84.

また、上記大径部９１の先端側の外周には、環状の切断刃９５が先端方向を向いて嵌着されている。この切断刃９５は、上記圧入部９０を第１部材５２の突き当て部８５に当接させて結紮ワイヤ５０を挟持したときに、該挟持位置よりも基端側で結紮ワイヤ５０を切断するようになっている。また、この際、切断刃９５の先端は、突き当て面８６に当接するようになっている。
即ち、該切断刃９５及び上記突き当て面８６は、上記切断手段５９を構成している。 An annular cutting blade 95 is fitted on the outer periphery of the large-diameter portion 91 on the distal end side so as to face the distal direction. The cutting blade 95 is configured to cut the ligature wire 50 on the proximal end side with respect to the clamping position when the press-fitting portion 90 is brought into contact with the abutting portion 85 of the first member 52 and the ligature wire 50 is clamped. It has become. At this time, the tip of the cutting blade 95 comes into contact with the abutting surface 86.
That is, the cutting blade 95 and the abutting surface 86 constitute the cutting means 59.

更に、大径部９１の基端側には、上記側孔８８により第１部材５２の外部に導かれた結紮ワイヤ５０を第２部材５３の内部に導く一対のスリット状のワイヤガイド９６が形成されている。該ワイヤガイド９６により内部に導かれた結紮ワイヤ５０は、内側シース５４内に挿入されて、上記折り返し部５０ｂを介して係合部材６６ａに係合されるようになっている。また、大径部９１の外周には、ワイヤガイド９６から軸線を中心に周方向に９０度偏倚した位置に、第１部材５２の上記係止孔８９に嵌合可能な一対の上記係合爪６０が設けられている。該係合爪６０は、大径部９１の外周面から、半径方向外方に向けて突出するように形成されており、上記圧入部９０を突き当て部８５に当接させたときに、係止孔８９に嵌合するようになっている。即ち、該係合爪６０及び上記係止孔８９は、上記係止手段５８を構成している。   Furthermore, a pair of slit-shaped wire guides 96 are formed on the proximal end side of the large-diameter portion 91 to guide the ligating wire 50 guided to the outside of the first member 52 through the side holes 88 to the inside of the second member 53. Has been. The ligating wire 50 guided to the inside by the wire guide 96 is inserted into the inner sheath 54 and engaged with the engaging member 66a through the folded portion 50b. Further, on the outer periphery of the large-diameter portion 91, a pair of the engaging claws that can be fitted into the engaging hole 89 of the first member 52 at a position offset from the wire guide 96 by 90 degrees in the circumferential direction around the axis. 60 is provided. The engaging claw 60 is formed so as to protrude radially outward from the outer peripheral surface of the large-diameter portion 91, and when the press-fitting portion 90 is brought into contact with the abutting portion 85, the engaging claw 60 is engaged. It fits into the stop hole 89. That is, the engaging claw 60 and the locking hole 89 constitute the locking means 58.

また、この係合爪６０は、係止孔８９内に嵌合したときに、上記連結フック７６の爪部７６ａを係止孔８９内から第１部材５２の外部に押し出し、第１部材５２と連結フック７ ６との接続、即ち、接続手段５７の接続を解く機能を有している。
なお、係合爪６０は、図８に示すように、両係合爪６０間の距離Ｌ１が、係止孔８９間の距離Ｌ２以上の距離であることが好ましい。こうすることで、係止孔８９内から爪部７６ａを確実に押し出すことが可能である。 Further, when the engaging claw 60 is fitted in the locking hole 89, the claw portion 76 a of the connecting hook 76 is pushed out from the locking hole 89 to the outside of the first member 52, It has a function of releasing the connection with the connecting hook 76, that is, the connection means 57.
As shown in FIG. 8, the engagement claw 60 preferably has a distance L <b> 1 between the engagement claws 60 equal to or greater than a distance L <b> 2 between the locking holes 89. By doing so, it is possible to reliably push out the claw portion 76a from the inside of the locking hole 89.

このように構成された医療用処置具１により、体内の生体組織の病変部を結紮する場合について以下に説明する。
まず、図１に示す操作部１１に配された所望するスイッチ２５を押下して光源装置３０を作動させ、該光源装置３０から発せられた照明光をＬＧファイババンドル２１を介して照明レンズ１４から出射させる。また、プロセッサ３１内のＣＣＤドライブ回路３６を作動させて内視鏡ＣＣＤ１７を駆動させる。
この状態で、内視鏡挿入部１０を被検者の体内に、例えば、口から挿入する。この際、操作部１１に設けられた操作ノブ２６を操作することにより、内視鏡挿入部１０の先端の湾曲部１２を所望する方向に向けながら挿入する。こうすることで、内視鏡挿入部１０を円滑に体内に挿入することができると共に、観察したい所望位置に照明光の照射を確実に行える。 The case where the lesioned part of the biological tissue in the body is ligated with the medical treatment instrument 1 configured as described above will be described below.
First, a desired switch 25 arranged in the operation unit 11 shown in FIG. 1 is pressed to activate the light source device 30, and illumination light emitted from the light source device 30 is transmitted from the illumination lens 14 via the LG fiber bundle 21. Let it emit. Further, the CCD drive circuit 36 in the processor 31 is operated to drive the endoscope CCD 17.
In this state, the endoscope insertion portion 10 is inserted into the body of the subject, for example, from the mouth. At this time, by operating the operation knob 26 provided in the operation unit 11, the bending portion 12 at the distal end of the endoscope insertion unit 10 is inserted in a desired direction. By doing so, the endoscope insertion portion 10 can be smoothly inserted into the body, and illumination light can be reliably irradiated to a desired position to be observed.

また、対物レンズ１６を介して内視鏡ＣＣＤ１７によって撮像された撮像信号は、ケーブル１８、２７、３８を介してプロセッサ３１に送られ、映像処理回路３７によって映像信号に変換される。変換された映像信号は、記録装置３２によって記録されると共にモニタ３９に送られて内視鏡画像として表示される。この際、入力手段４０から所定の情報、例えば、被検者名、被検者ＩＤ番号、観察部位等の情報を入力することにより、モニタ３９に内視鏡画像と共に表示することが可能である。   Further, an image signal picked up by the endoscope CCD 17 via the objective lens 16 is sent to the processor 31 via the cables 18, 27, and 38 and converted into a video signal by the video processing circuit 37. The converted video signal is recorded by the recording device 32 and sent to the monitor 39 to be displayed as an endoscopic image. At this time, by inputting predetermined information such as a subject name, a subject ID number, and an observation site from the input means 40, it can be displayed on the monitor 39 together with the endoscopic image. .

そして、医師が、モニタ３９に表示される内視鏡画像により、内視鏡挿入部１０の先端が結紮を行う病変部に達したことを確認すると、モニタ３９を見ながら該内視鏡挿入部１０の先端を病変部の近傍に位置させる。次に、この状態で、医師は、医療用処置具１を、内視鏡装置３の処置具挿通孔１５より処置具チャンネル４内に挿入する。この際、医師は、グリップ７２を先端方向に移動させて、図２に示すように、外側シース６５を結紮ワイヤ５０のループ部５０ａを覆うように被せた状態で、処置具チャンネル４内に挿入する。つまり、ループ部５０ａは、外側シース６５の内部に窄まった状態で収納されている。
また、このとき、図３及び図４に示すように、第１部材５２の挿入軸８２の端部は、第２部材５３の内腔９２に設けられた突起９３に当接しているので、容易に基端方向に向けて移動しないようになっている。これにより、医療用処置具１を処置具チャンネル４内に挿入するときに、不意に第１部材５２が、第２部材５３に向けて移動しないようになっている。 Then, when the doctor confirms from the endoscopic image displayed on the monitor 39 that the distal end of the endoscope insertion unit 10 has reached the lesioned part to be ligated, the endoscope insertion unit while viewing the monitor 39 The tip of 10 is positioned in the vicinity of the lesion. Next, in this state, the doctor inserts the medical treatment instrument 1 into the treatment instrument channel 4 through the treatment instrument insertion hole 15 of the endoscope apparatus 3. At this time, the doctor moves the grip 72 in the distal direction, and inserts it into the treatment instrument channel 4 with the outer sheath 65 covering the loop portion 50a of the ligature wire 50 as shown in FIG. To do. That is, the loop portion 50a is housed in a state of being constricted inside the outer sheath 65.
At this time, as shown in FIGS. 3 and 4, the end of the insertion shaft 82 of the first member 52 is in contact with the projection 93 provided in the lumen 92 of the second member 53, so that it is easy. It does not move toward the proximal direction. Thereby, when the medical treatment instrument 1 is inserted into the treatment instrument channel 4, the first member 52 is not moved unexpectedly toward the second member 53.

そして、医師は、モニタ３９に表示される内視鏡画像により、内視鏡挿入部１０の先端面より挿入部６３が突出したことを確認後、グリップ７２を基端方向に移動させて、第１部材５２及び第２部材５３が露出する程度まで外側シース６５を後退させる。これにより、図３に示すように、結紮ワイヤ５０のループ部５０ａが外側シース６５内から解放され、弾性的に復元して拡径する。ループ部５０ａの拡径後、医師は、モニタ３９に表示される内視鏡画像を確認しながら内視鏡を操作して、ループ部５０ａを病変部に引っ掛ける。   Then, after confirming that the insertion portion 63 protrudes from the distal end surface of the endoscope insertion portion 10 based on the endoscope image displayed on the monitor 39, the doctor moves the grip 72 in the proximal direction, The outer sheath 65 is retracted to such an extent that the first member 52 and the second member 53 are exposed. Thereby, as shown in FIG. 3, the loop part 50a of the ligation wire 50 is released from the inside of the outer sheath 65, and is elastically restored to expand its diameter. After expanding the diameter of the loop portion 50a, the doctor operates the endoscope while checking the endoscope image displayed on the monitor 39, and hooks the loop portion 50a on the lesioned portion.

ループ部５０ａを引っ掛けた後、線材操作部５１を操作して結紮ワイヤ５０を基端方向に移動させる。即ち、スライダ７１を基端方向に向けて移動させることにより、操作ワイヤ６６を後退させ、係合部材６６ａを介して結紮ワイヤ５０を基端方向に向けて移動させる。この際、第１部材５２は、接続手段５７、即ち、係止孔８９及び連結フック７６により嵌合シース５５に接続されているので、結紮ワイヤ５０のみが、第１部材５２の先端孔８７から該第１部材５２の内部に引き込まれる。これにより、ループ部５０ａが縮径して病変部が緊縛（結紮）される。この結紮により、病変部への血流を止めることができる。
また、スライダ７１の操作の際、医師は、上述したように、指かけリング７３を利用することによって、モニタ３９を見ながら片手で容易に操作を行うことができる。また、ループ部５０ａを引っ掛ける際に、第１部材５２を病変部に押し付けるように位置させることによって、病変部の結紮が容易に行える。 After hooking the loop part 50a, the wire rod operating part 51 is operated to move the ligating wire 50 in the proximal direction. That is, the operation wire 66 is moved backward by moving the slider 71 in the proximal direction, and the ligation wire 50 is moved in the proximal direction via the engaging member 66a. At this time, since the first member 52 is connected to the fitting sheath 55 by the connecting means 57, that is, the locking hole 89 and the connecting hook 76, only the ligating wire 50 is removed from the distal end hole 87 of the first member 52. It is drawn into the first member 52. As a result, the diameter of the loop portion 50a is reduced and the lesioned portion is tightly bound (ligated). This ligation can stop blood flow to the lesion.
Further, when operating the slider 71, the doctor can easily operate with one hand while looking at the monitor 39 by using the finger ring 73 as described above. Further, when the loop portion 50a is hooked, the lesioned portion can be easily ligated by positioning the first member 52 so as to press the lesioned portion.

医師は、モニタ３９に表示された内視鏡画像により、病変部が確実に緊縛されたことを確認後、嵌合グリップ５６を基端方向に移動させて、嵌合シース５５を後退させる。該嵌合シース５５が後退すると、図４及び図５に示すように、接続手段５７によって、嵌合シース５５と第１部材５２とが接続されているので、第１部材５２が基端方向、即ち、第２部材５３に向けて移動する。なお、この際、第１部材５２の挿入軸８２の端部と突起９３との当接状態に打ち勝つ力で嵌合グリップ５６を操作する。これにより、挿入軸８２が、突起９３を乗り越えて内腔内９２内に挿入される。   The doctor moves the fitting grip 56 in the proximal direction and moves the fitting sheath 55 backward after confirming that the lesioned part is securely bound by the endoscopic image displayed on the monitor 39. When the fitting sheath 55 is retracted, as shown in FIGS. 4 and 5, the fitting sheath 55 and the first member 52 are connected by the connecting means 57, so that the first member 52 is in the proximal direction. That is, it moves toward the second member 53. At this time, the fitting grip 56 is operated with a force that overcomes the contact state between the end of the insertion shaft 82 of the first member 52 and the protrusion 93. As a result, the insertion shaft 82 is inserted into the lumen 92 over the projection 93.

つまり、相対的移動により、圧入部９０が、挿入軸８２に沿って先端方向に移動し、固定用内腔内８４に圧入される。従って、固定用内腔８４内の結紮ワイヤ５０は、固定用内腔８４の内面と圧入部９０の外面との間に挟持され始める。そして、さらなる移動によって、圧入部９０が突き当て部８５に当接して、結紮ワイヤ５０を確実に挟持して固定する。また、この際、図１５及び図１６に示すように、第２部材５３の切断刃９５が、結紮ワイヤ５０の挟持位置の基端側で該結紮ワイヤ５０を切断して、切断後、先端が突き当て面８６に当接する。また、切断刃９５は、第１部材５２の内部にて、結紮ワイヤ５０を切断するので、結紮ワイヤ５０の切断端部が、第１部材５２の外部に露出することはない。   That is, due to the relative movement, the press-fitting portion 90 moves in the distal direction along the insertion shaft 82 and is press-fitted into the fixing lumen 84. Accordingly, the ligating wire 50 in the fixing lumen 84 starts to be sandwiched between the inner surface of the fixing lumen 84 and the outer surface of the press-fit portion 90. Then, by further movement, the press-fit portion 90 comes into contact with the abutting portion 85, and the ligature wire 50 is securely clamped and fixed. At this time, as shown in FIGS. 15 and 16, the cutting blade 95 of the second member 53 cuts the ligating wire 50 on the proximal end side of the clamping position of the ligating wire 50, and after cutting, the distal end is It abuts against the abutting surface 86. Further, since the cutting blade 95 cuts the ligating wire 50 inside the first member 52, the cut end portion of the ligating wire 50 is not exposed to the outside of the first member 52.

更に、圧入部９０が突き当て部８５に当接した際に、図１７に示すように、第２部材５３の係合爪６０が、接続手段５７の接続を解く。即ち、係合爪６０が、第１部材５２の係止孔８９内に嵌合すると共に、連結フック７６の爪部７６ａを第１部材５２の外部に押し出す。また、係合爪６０及び係止孔８９は、係止手段５８を構成しているので、同時に第１部材５２と第２部材５３とが係止状態となる。
上述したように、第１部材５２と第２部材５３とが、結紮ワイヤ５０を間に挟持した状態で、互いに係止されると共に連結フック７６と第１部材５２との接続が解かれる。
医師は、モニタ３９に表示されている内視鏡画像、例えば、第１部材５２と第２部材５３とが互いに係止されたことを見て、確実に結紮ワイヤ５０の挟持及び切断が行われたことを確認後、手元操作部６４を操作して、挿入部６３の先端を病変部からゆっくりと離間させる。これにより、図１８に示すように、第１部材５２及び第２部材５３によって緊縛状態に保持された結紮ワイヤ５０が、体内に留置される。これにより、病変部の緊縛処置が終了する。 Further, when the press-fitting portion 90 abuts against the abutting portion 85, the engaging claws 60 of the second member 53 release the connection means 57 as shown in FIG. That is, the engaging claw 60 is fitted into the locking hole 89 of the first member 52 and pushes the claw portion 76 a of the connecting hook 76 to the outside of the first member 52. Moreover, since the engaging claw 60 and the locking hole 89 constitute the locking means 58, the first member 52 and the second member 53 are simultaneously locked.
As described above, the first member 52 and the second member 53 are locked together with the ligating wire 50 sandwiched therebetween, and the connection between the connecting hook 76 and the first member 52 is released.
The doctor sees the endoscopic image displayed on the monitor 39, for example, that the first member 52 and the second member 53 are locked together, and the ligation wire 50 is securely held and cut. After confirming this, the hand operating part 64 is operated to slowly separate the distal end of the insertion part 63 from the lesioned part. Thereby, as shown in FIG. 18, the ligature wire 50 held in a tightly bound state by the first member 52 and the second member 53 is left in the body. Thereby, the binding treatment of the lesioned part is completed.

上述したように、本実施形態の医療用処置具１によれば、病変部を介さずに、第１部材５２を第２部材５３の方向に移動させて、両部材５２、５３間で結紮ワイヤ５０を挟持して固定すると共に、挟持位置後方で切断することができる。従って、病変部の状態に係わらず、確実に結紮ワイヤ５０の挟持固定及び切断を行うことができるので、結紮処置の操作性、及び正確性を向上することができる。
また、結紮ワイヤ５０の挟持固定及び切断操作を嵌合グリップ５６の一連の操作により行うことができるので、時間を掛けずに効率の良い結紮作業を行うことができる。
また、結紮ワイヤ５０の切断端部が第１部材５２の外部に露出しないように、切断刃９５が第１部材５２の内部にて結紮ワイヤ５０を切断するので、他の処置具や内視鏡挿入部１０への干渉を防止することができる。
更に、切断刃９５は、医療用結紮具６１である第２部材５３に設けられているので、切断刃９５を繰り返し使用することはない。従って、切断刃９５は、常に新品状態であるので、切れ味が低下することはない。
また、係止手段５８は、接続手段５７の係止孔８９と、接続解放手段である係合爪６０を利用して構成されているので、専用の係止手段を別個に設ける必要はない。従って、構成の容易化を図ることができる。 As described above, according to the medical treatment instrument 1 of the present embodiment, the first member 52 is moved in the direction of the second member 53 without passing through the lesion, and the ligation wire is between the members 52 and 53. 50 can be clamped and fixed, and can be cut behind the clamping position. Therefore, since the ligation wire 50 can be securely clamped and cut regardless of the state of the lesion, the operability and accuracy of the ligation procedure can be improved.
Further, since the pinching and fixing operation of the ligation wire 50 can be performed by a series of operations of the fitting grip 56, an efficient ligation operation can be performed without taking time.
Further, since the cutting blade 95 cuts the ligature wire 50 inside the first member 52 so that the cut end portion of the ligature wire 50 is not exposed to the outside of the first member 52, other treatment tools and endoscopes are used. Interference with the insertion portion 10 can be prevented.
Further, since the cutting blade 95 is provided on the second member 53 that is the medical ligation tool 61, the cutting blade 95 is not used repeatedly. Therefore, since the cutting blade 95 is always in a new state, the sharpness does not deteriorate.
Further, since the locking means 58 is configured using the locking hole 89 of the connection means 57 and the engagement claw 60 as the connection release means, it is not necessary to provide a dedicated locking means separately. Therefore, simplification of the configuration can be achieved.

次に、本発明に係る医療用処置具の第２実施形態を、図１９から図３５を参照して以下に説明する。なお、この第２実施形態においては、第１実施形態における構成要素と同一の部分については、同一の符号を付しその説明を省略する。
第２実施形態と第１実施形態との異なる点は、第１実施形態の医療用処置具１では、切断刃９５が第２部材５３に設け、結紮ワイヤ５０の挟持及び切断を同時に行っていたのに対し、第２実施形態の医療用処置具１００では、第２部材５３とは別に切断刃９５を有する切断部材１０１が設けられて、第１部材５２と第２部材５３とが係止した後に、切断部材１０１により結紮ワイヤ５０を切断する点である。 Next, 2nd Embodiment of the medical treatment tool which concerns on this invention is described below with reference to FIGS. In the second embodiment, the same components as those in the first embodiment are denoted by the same reference numerals, and the description thereof is omitted.
The difference between the second embodiment and the first embodiment is that in the medical treatment tool 1 of the first embodiment, the cutting blade 95 is provided on the second member 53, and the ligation wire 50 is sandwiched and cut simultaneously. On the other hand, in the medical treatment instrument 100 of the second embodiment, the cutting member 101 having the cutting blade 95 is provided separately from the second member 53, and the first member 52 and the second member 53 are locked. Later, the ligating wire 50 is cut by the cutting member 101.

即ち、本実施形態の医療用処置具１００は、図１９から図３０に示すように、嵌合シース５５の先端に設けられ、結紮ワイヤ５０を第１部材５２と第２部材５３との間で挟持する挟持位置よりも基端側で切断する切断刃９５を結紮ワイヤ５０よりも先端側に配する上記切断部材１０１を備えている。該切断部材１０１は、ステンレス等の金属により、連結パイプ７５及び第２部材５３を覆うように略円筒状に形成されると共に、第１部材５２と同一外径になるように形成されている。切断部材１０１の先端側には、先端を二股に分けて一対の先端アーム１０２が先端方向に突出するように先端スリット１０３が形成されている。この先端アーム１０２の外表面の中心には、軸方向に伸びたワイヤスリット１０４が形成されており、該ワイヤスリット１０４内に第１部材５２と第２部材５３との間で外部に露出した結紮ワイヤ５０を挿通できるようになっている。また、先端アーム１０２は、第１部材５２の円柱部８０の基端側に形成された後述するアーム受け部８０ａ内に嵌るようになっている。また、ワイヤスリット１０４の先端縁には、上記切断刃９５が形成されている。これにより、切断刃９５は、結紮ワイヤ５０よりも先端側に配されるようになっている。なお、切断刃９５は、先端アーム１０２の先端を図１９に示すように、アーム受け部８０ａの突き当て面８０ｂに当接させたときに、アーム受け部８０ａから基端側にでないように形成されている。   That is, as shown in FIGS. 19 to 30, the medical treatment tool 100 of the present embodiment is provided at the distal end of the fitting sheath 55, and the ligation wire 50 is interposed between the first member 52 and the second member 53. The cutting member 101 is provided that has a cutting blade 95 for cutting on the proximal end side with respect to the clamping position for clamping, on the distal end side with respect to the ligature wire 50. The cutting member 101 is made of a metal such as stainless steel so as to cover the connecting pipe 75 and the second member 53, and is formed to have the same outer diameter as the first member 52. On the distal end side of the cutting member 101, a distal end slit 103 is formed so that the distal end is divided into two forks and a pair of distal end arms 102 protrude in the distal direction. A wire slit 104 extending in the axial direction is formed at the center of the outer surface of the tip arm 102, and a ligature exposed to the outside between the first member 52 and the second member 53 in the wire slit 104. The wire 50 can be inserted. Further, the distal arm 102 is adapted to fit in an arm receiving portion 80a described later formed on the proximal end side of the cylindrical portion 80 of the first member 52. Further, the cutting blade 95 is formed at the leading edge of the wire slit 104. As a result, the cutting blade 95 is arranged on the distal end side with respect to the ligating wire 50. As shown in FIG. 19, the cutting blade 95 is formed so as not to be on the proximal side from the arm receiving portion 80a when the distal end of the distal end arm 102 is brought into contact with the abutting surface 80b of the arm receiving portion 80a. Has been.

また、上記先端スリット１０３は、第１部材５２の係止孔８９及び第２部材５３の係合爪６０に干渉しない大きさに形成されている。また、先端スリット１０３の基端側には、更に基端方向に向けて延在したフック用スリット１０５が形成されており、連結フック７６に干渉しないようになっている。
また、切断部材１０１の基端側には、ワイヤスリット１０４と同一軸上において基端方向に延在するよう一対の連結アーム１０６が形成されている。そして、この連結アーム１０６の先端には、半径方向内方に向けて突出した連結爪１０７が形成されている。 The tip slit 103 is formed in a size that does not interfere with the locking hole 89 of the first member 52 and the engaging claw 60 of the second member 53. Further, a hook slit 105 extending further in the proximal direction is formed on the proximal end side of the distal slit 103 so as not to interfere with the connecting hook 76.
A pair of connecting arms 106 are formed on the base end side of the cutting member 101 so as to extend in the base end direction on the same axis as the wire slit 104. A connecting claw 107 projecting inward in the radial direction is formed at the tip of the connecting arm 106.

また、本実施形態の連結パイプ７５の外表面には、上記連結爪１０７が嵌合可能な一対の連結孔７５ｂが形成されている。つまり、この連結孔７５ｂは、連結パイプ７５の基端側で、連結フック７６から軸線を中心に周方向に９０度偏倚した位置に形成されている。
つまり、連結アーム１０６の連結爪１０７を連結孔７５ｂに嵌合させることにより、切断部材１０１を連結パイプ７５に接続して嵌合シース５５の先端方向に装着できるようになっている。このように、切断部材１０１は、連結アーム１０６により嵌合シース５５に着脱可能となっている。
なお、連結孔７５ｂは、図２２に示すように、軸方向に長手方向を有する長方形状となっており、先端アーム１０２の先端を図１９に示すように、アーム受け部８０ａの突き当て面８０ｂに当接させたときに、連結爪１０７が、連結孔７５ｂの略中間部に位置するようになっている。つまり、連結爪１０７を連結孔７５ｂに嵌合させた状態で、嵌合シース５５は軸方向に若干移動できるようになっている。 Further, a pair of connection holes 75b into which the connection claws 107 can be fitted are formed on the outer surface of the connection pipe 75 of the present embodiment. That is, the connection hole 75b is formed at a position that is deviated 90 degrees from the connection hook 76 in the circumferential direction around the axis on the proximal end side of the connection pipe 75.
That is, by fitting the coupling claw 107 of the coupling arm 106 into the coupling hole 75 b, the cutting member 101 can be connected to the coupling pipe 75 and mounted in the distal direction of the fitting sheath 55. As described above, the cutting member 101 can be attached to and detached from the fitting sheath 55 by the connecting arm 106.
The connecting hole 75b has a rectangular shape having a longitudinal direction in the axial direction as shown in FIG. 22, and the tip of the tip arm 102 is abutting surface 80b of the arm receiving portion 80a as shown in FIG. The connecting claw 107 is positioned substantially in the middle of the connecting hole 75b. That is, the fitting sheath 55 can move slightly in the axial direction in a state where the connecting claw 107 is fitted in the connecting hole 75b.

また、本実施形態の第１部材５２は、上述したように、円柱部８０の基端側に、縮径したアーム受け部８０ａが形成されており、該外径アーム受け部８０ａの先端側側面が突き当て面８０ｂとなっている。なお、アーム受け部８０ａは、第１部材５２の外径と先端アー１０２の外径との間に段差ができないようにその外径が設定されている。更に、第１部材５２は、円筒部８１にスリット１１１が形成され、該スリット１１１より固定用内腔８４内から結紮ワイヤ５０を第１部材５２の外部に導くようになっている。また、第１部材５２の先端は、先端方向に向けて順次径が小さくなるようテーパ部１１２が形成されている、
また、本実施形態の第２部材５３は、大径部９１の略中間部に、上記スリット１１１から第１部材５２の外部に導かれた結紮ワイヤ５０を第２部材５３の内部に導く一対の側孔１１３が形成されている。該側孔１１３により内部に導かれた結紮ワイヤ５０は、内側シース５４に挿入されて、折り返し部５０ｂを介して係合部材６６ａに係合されるようになっている。 Further, as described above, the first member 52 of the present embodiment has the arm receiving portion 80a having a reduced diameter formed on the proximal end side of the cylindrical portion 80, and the side surface on the distal end side of the outer diameter arm receiving portion 80a. Is the butting surface 80b. The arm receiving portion 80a has an outer diameter so that there is no step between the outer diameter of the first member 52 and the outer diameter of the distal end arm 102. Further, the first member 52 has a slit 111 formed in the cylindrical portion 81, and guides the ligating wire 50 from the inside of the fixing lumen 84 to the outside of the first member 52 through the slit 111. Further, the tip of the first member 52 is formed with a tapered portion 112 so that the diameter gradually decreases toward the tip.
Further, the second member 53 of the present embodiment has a pair of ligating wires 50 guided to the outside of the first member 52 from the slit 111 to the inside of the second member 53 at a substantially intermediate portion of the large diameter portion 91. Side holes 113 are formed. The ligating wire 50 guided to the inside by the side hole 113 is inserted into the inner sheath 54 and engaged with the engaging member 66a through the folded portion 50b.

また、第１部材５２の先端には、ステンレス等の金属、又はＡＢＳ、シリコン樹脂等のプラスチック材料により円筒状に形成された筒状部材１１５が配されている。結紮ワイヤ５０は、該筒状部材１１５の内部を通った後に、第１部材５２の先端孔８７より第１部材５２の内部に挿入されるようになっている。また、筒状部材１１５の基端側には、基端方向に向けて順次径が小さくなるようテーパ部１１６が形成されている。このテーパ部１１６及び上記第１部材５２のテーパ部１１２は、環状凹部１１７を構成している。
なお、本実施形態においては、この筒状部材１１５も、医療用結紮具６１を構成している一部である。 A cylindrical member 115 formed in a cylindrical shape from a metal such as stainless steel or a plastic material such as ABS or silicon resin is disposed at the tip of the first member 52. The ligating wire 50 is inserted into the first member 52 through the tip hole 87 of the first member 52 after passing through the cylindrical member 115. Further, a taper portion 116 is formed on the proximal end side of the cylindrical member 115 so that the diameter gradually decreases in the proximal direction. The tapered portion 116 and the tapered portion 112 of the first member 52 constitute an annular recess 117.
In the present embodiment, the tubular member 115 is also a part of the medical ligation tool 61.

また、本実施形態においては、まず医療用結紮具６１、即ち、結紮ワイヤ５０、筒状部材１１５、第１部材５２及び第２部材５３を組み合わせた後、図２３から図２５に示すように、該医療用結紮具６１に切断部材１０１を装着する。即ち、切断部材１０１を先端アーム１０２側から第２部材５３側を覆うように挿入すると共に、先端アーム１０２の先端を第１部材５２のアーム受け部８０ａの突き当て面８０ｂに当接させて装着する。この際、先端アーム１０２を外方に押し広げることにより、ワイヤスリット１０４内に結紮ワイヤ５０を挿通させ易い。なお、予め第１部材５２、第２部材５３及び切断部材１０１を組み合わせた後に、結紮ワイヤ５０を装着しても構わない。   Moreover, in this embodiment, after combining the medical ligation tool 61, ie, the ligation wire 50, the cylindrical member 115, the first member 52, and the second member 53, as shown in FIGS. The cutting member 101 is attached to the medical ligation tool 61. That is, the cutting member 101 is inserted from the tip arm 102 side so as to cover the second member 53 side, and the tip of the tip arm 102 is brought into contact with the abutment surface 80b of the arm receiving portion 80a of the first member 52. To do. At this time, it is easy to insert the ligating wire 50 into the wire slit 104 by pushing the distal arm 102 outward. The ligation wire 50 may be attached after the first member 52, the second member 53, and the cutting member 101 are combined in advance.

このように構成された医療用処置具１００により、体内の生体組織の病変部を結紮する場合について以下に説明する。
スライダ７１を先端方向に移動させて、係合部材６６ａを内側シース５４の先端開口から突出させる。この状態で、結紮ワイヤ５０の折り返し部５０ｂを係合部材６６ａに引っ掛ける。引っ掛けた後、スライダ７１を基端方向に移動させて、係合部材６６ａを内側シース５４内に引き込むと共に、切断部材１０１を連結パイプ７５の周囲に被せるように挿入し、連結アーム１０６の連結爪１０７を連結孔７５ｂに嵌合させる。
また、この際、図２１に示すように、嵌合シース５５の連結フック７６をフック用スリット１０５から一旦切断部材１０１の外部に出し、その後、第１部材５２の係止孔８９に嵌合させる。
これにより、図１９から図２１に示すように、第１部材５２と嵌合シース５５とが、接続手段５７により互いに接続されると共に、嵌合シース５５と切断部材１０１とが、連結爪１０７及び連結孔７５ｂにより互いに接続された状態となる。 The case where the lesioned part of the biological tissue in the body is ligated with the medical treatment instrument 100 configured as described above will be described below.
The slider 71 is moved in the distal direction, and the engaging member 66a is projected from the distal end opening of the inner sheath 54. In this state, the folded portion 50b of the ligating wire 50 is hooked on the engaging member 66a. After the hooking, the slider 71 is moved in the proximal direction, the engaging member 66a is pulled into the inner sheath 54, and the cutting member 101 is inserted so as to cover the connecting pipe 75. 107 is fitted into the connecting hole 75b.
At this time, as shown in FIG. 21, the connecting hook 76 of the fitting sheath 55 is once taken out of the cutting member 101 from the hook slit 105 and then fitted into the locking hole 89 of the first member 52. .
Accordingly, as shown in FIGS. 19 to 21, the first member 52 and the fitting sheath 55 are connected to each other by the connecting means 57, and the fitting sheath 55 and the cutting member 101 are connected to the connecting claw 107 and The connection holes 75b are connected to each other.

そして、医師は、モニタ３９に表示される内視鏡画像を見ながら、内視鏡を操作して、ループ部５０ａを病変部に引っ掛ける。該ループ部５０ａを引っ掛けた後、スライダ７１を基端方向に向けて移動させることにより、操作ワイヤ６６を後退させ、係合部材６６ａを介して結紮ワイヤ５０を基端方向に向けて移動させる。この際、第１部材５２は、接続手段５７、即ち、係止孔８９及び連結フック７６により嵌合シース５５に接続されているので、結紮ワイヤ５０のみが、第１部材５２の先端孔８７から該第１部材５２の内部に引き込まれる。また、切断部材１０１は、第１部材５２が移動しないので、同様に移動することはない。これにより、ループ部５０ａが縮径して病変部が緊縛（結紮）される。この結紮により、病変部への血流を止めることができる。
また、ループ部５０ａを引っ掛ける際に、筒状部材１１５を病変部に押し付けるように位置させることによって、病変部の結紮が容易に行える。 Then, the doctor operates the endoscope while observing the endoscope image displayed on the monitor 39, and hooks the loop portion 50a on the lesioned portion. After hooking the loop portion 50a, the slider 71 is moved in the proximal direction to retract the operation wire 66, and the ligating wire 50 is moved in the proximal direction via the engaging member 66a. At this time, since the first member 52 is connected to the fitting sheath 55 by the connecting means 57, that is, the locking hole 89 and the connecting hook 76, only the ligating wire 50 is removed from the distal end hole 87 of the first member 52. It is drawn into the first member 52. Further, since the first member 52 does not move, the cutting member 101 does not move similarly. As a result, the diameter of the loop portion 50a is reduced and the lesioned portion is tightly bound (ligated). This ligation can stop blood flow to the lesion.
In addition, when the loop portion 50a is hooked, the tubular member 115 is positioned so as to be pressed against the lesioned portion, so that the lesioned portion can be easily ligated.

病変部の緊縛後、嵌合グリップ５６を基端方向に移動させて、嵌合シース５５を後退させる。該嵌合シース５５が後退すると、接続手段５７によって、嵌合シース５５と第１部材５２とが接続されているので、第１部材５２が基端方向、即ち、第２部材５３に向けて移動する。また、切断部材１０１の先端アーム１０２の先端は、突き当て面８０ｂに当接しているので、第１部材５２の基端方向に移動に伴って、切断部材１０１も押されて一体的に基端方向に移動する。この際、第１部材５２と切断部材１０１との相対位置関係が変化しないので、切断刃９５がアーム受け部８０ｂより基端側に出ることはない。
なお、上記第１実施形態と同様に、第１部材５２の挿入軸８２の端部と突起９３との当接状態に打ち勝つ力で嵌合グリップ５６を操作して、突起９３を乗り越えるように挿入軸８２を内腔内９２内に挿入する。 After the lesion part is bound, the fitting grip 56 is moved in the proximal direction, and the fitting sheath 55 is retracted. When the mating sheath 55 is retracted, the mating sheath 55 and the first member 52 are connected by the connecting means 57, so that the first member 52 moves toward the proximal direction, that is, toward the second member 53. To do. In addition, since the distal end of the distal arm 102 of the cutting member 101 is in contact with the abutting surface 80b, the cutting member 101 is also pushed together with the movement in the proximal direction of the first member 52, so that the proximal end is integrated. Move in the direction. At this time, since the relative positional relationship between the first member 52 and the cutting member 101 does not change, the cutting blade 95 does not protrude from the arm receiving portion 80b to the proximal end side.
As in the first embodiment, the fitting grip 56 is operated with a force that overcomes the contact state between the end of the insertion shaft 82 of the first member 52 and the protrusion 93, and is inserted so as to get over the protrusion 93. The shaft 82 is inserted into the lumen 92.

第１部材５２の移動により、圧入部９０が、挿入軸８２に沿って先端方向に移動し、固定用内腔内８４に圧入され、固定用内腔８４内の結紮ワイヤ５０が固定用内腔８４の内面と圧入部９０の外面との間に挟持され始める。そして、さらなる移動によって、図３１及び図３２に示すように、圧入部９０が突き当て部８５に当接して、結紮ワイヤ５０を確実に挟持して固定する。この際、結紮ワイヤ５０は、図３２に示すように、挟持位置の基端側で第１部材５２のスリット１１１から切断部材１０１のワイヤスリット１０４内に出た状態となっている。
また、図３１に示すように、第２部材５３の係合爪６０が、第１部材５２の係止孔８９内に嵌合すると共に、連結フック７６の爪部７６ａを第１部材５２の外部に押し出す。また、係合爪６０及び係止孔８９は、係止手段５８を構成しているので、同時に第１部材５２と第２部材５３とが係止状態となる。つまり、第１部材５２と第２部材５３とが、結紮ワイヤ５０を間に挟持した状態で、互いに係止されると共に連結フック７６と第１部材５２との接続が解かれる。 By the movement of the first member 52, the press-fitting portion 90 moves in the distal direction along the insertion shaft 82 and is press-fitted into the fixing lumen 84, and the ligation wire 50 in the fixing lumen 84 is fixed to the fixing lumen. It begins to be sandwiched between the inner surface of 84 and the outer surface of the press-fit portion 90. Further, as shown in FIGS. 31 and 32, the press-fitting portion 90 abuts against the abutting portion 85, and the ligation wire 50 is securely clamped and fixed by further movement. At this time, as shown in FIG. 32, the ligating wire 50 is in a state of protruding from the slit 111 of the first member 52 into the wire slit 104 of the cutting member 101 on the proximal end side of the clamping position.
Further, as shown in FIG. 31, the engaging claw 60 of the second member 53 is fitted into the locking hole 89 of the first member 52, and the claw portion 76 a of the connecting hook 76 is connected to the outside of the first member 52. Extrude into. Moreover, since the engaging claw 60 and the locking hole 89 constitute the locking means 58, the first member 52 and the second member 53 are simultaneously locked. That is, the first member 52 and the second member 53 are locked together with the ligating wire 50 sandwiched therebetween, and the connection between the connecting hook 76 and the first member 52 is released.

連結フック７６と第１部材５２との接続が解かれた後、嵌合グリップ５６を基端方向に引っ張ると、上述したように連結孔７５ｂと連結爪１０７との間に若干の遊びがあるので、嵌合シース５５のみが後退する。そして、さらなる嵌合シース５５の移動により、連結孔７５ｂの先端が連結爪１０７に当接し、切断部材１０１が嵌合シース５５と共に基端方向に移動する。そして、図３３及び図３４に示すように、切断刃９５が第１部材５２のアーム受け部８０ａから結紮ワイヤ５０に向けて移動して、該結紮ワイヤ５０を切断する。この際、結紮ワイヤ５０は、アーム受け部８０ａから外部に露出しないように切断される。   After the connection between the connection hook 76 and the first member 52 is released, if the fitting grip 56 is pulled in the proximal direction, there is some play between the connection hole 75b and the connection claw 107 as described above. Only the fitting sheath 55 is retracted. As the fitting sheath 55 further moves, the distal end of the coupling hole 75 b comes into contact with the coupling claw 107, and the cutting member 101 moves in the proximal direction together with the fitting sheath 55. Then, as shown in FIGS. 33 and 34, the cutting blade 95 moves from the arm receiving portion 80a of the first member 52 toward the ligating wire 50 to cut the ligating wire 50. At this time, the ligating wire 50 is cut so as not to be exposed to the outside from the arm receiving portion 80a.

医師は、モニタ３９に表示されている内視鏡画像、例えば、第１部材５２と第２部材５３との係止状態及び切断部材１０１が移動したことを見て、確実に結紮ワイヤ５０の挟持及び切断が行われたことを確認後、内視鏡を操作して、挿入部６３の先端を病変部からゆっくりと離間させる。その際、切断部材１０１も第１部材５２及び第２部材５３から取り外される。これにより、第１部材５２及び第２部材５３によって緊縛状態に保持された結紮ワイヤ５０が、体内に留置される。これにより、病変部の緊縛処置が終了する。   The doctor sees the endoscopic image displayed on the monitor 39, for example, the locked state of the first member 52 and the second member 53 and the movement of the cutting member 101, and securely holds the ligation wire 50. After confirming that the cutting has been performed, the endoscope is operated to slowly separate the distal end of the insertion portion 63 from the lesioned portion. At that time, the cutting member 101 is also detached from the first member 52 and the second member 53. As a result, the ligature wire 50 held in a tightly bound state by the first member 52 and the second member 53 is placed in the body. Thereby, the binding treatment of the lesioned part is completed.

なお、上述した、結紮ワイヤ５０の切断の際、内側シース５４を押して筒状部材１１５を病変部に押し付けると共に、操作ワイヤ６６を引いた状態で、嵌合シース５５を手前に引いて第１部材５２と第２部材５３とを係止することで、より確実に病変部を結紮した状態で、結紮ワイヤ５０の挟持固定を行うことができる。
ここで、仮に、病変部の結紮状態が緩かった場合には、病変部の結紮状態を解くように結紮ワイヤ５０を切断して、再度病変部の結紮を行うことが可能である。つまり、医療用処置具１００を処置具チャンネル４内から取り出した後、医師は、例えば、図３５に示すような一対の切断刃１２０有する公知の挟鉗子を挿入して、モニタ３９の内視鏡画像を見ながら、環状凹部１１７から切断刃１２０を入れて結紮ワイヤ５０を切断する（なお、図３５においては、判り易いように挟鉗子の切断刃１２０のみを図示している）。この際、環状凹部１１７により、切断刃１２０は第１部材５２と筒状部材１１５との間に案内される。従って、医師は、モニタ３９を見ながらでも容易に挟鉗子を操作して結紮ワイヤ５０を切断することができる。 When the ligating wire 50 is cut as described above, the inner sheath 54 is pushed to push the tubular member 115 against the lesioned part, and the operation member 66 is pulled, and the fitting sheath 55 is pulled forward to pull the first member. By locking 52 and the second member 53, the ligation wire 50 can be clamped and fixed in a state where the lesioned part is ligated more reliably.
Here, if the ligation state of the lesioned part is loose, it is possible to cut the ligation wire 50 so as to release the ligation state of the lesioned part and ligate the lesioned part again. That is, after taking out the medical treatment instrument 100 from the treatment instrument channel 4, the doctor inserts a known clamping forceps having a pair of cutting blades 120 as shown in FIG. While observing the image, the cutting blade 120 is inserted from the annular recess 117 to cut the ligature wire 50 (in FIG. 35, only the cutting blade 120 for pinching forceps is shown for easy understanding). At this time, the cutting blade 120 is guided between the first member 52 and the cylindrical member 115 by the annular recess 117. Therefore, the doctor can easily cut the ligature wire 50 by operating the forceps while looking at the monitor 39.

上述したように、本実施形態の医療用処置具１００によれば、病変部を介さずに、第１部材５２を第２部材５３の方向に移動させて、両部材５２、５３間で結紮ワイヤ５０を挟持して固定することができる。また、結紮ワイヤ５０の固定後、切断部材１０１により結紮ワイヤ５０を挟持位置後方で切断することができる。このように、結紮ワイヤ５０の切断を行う前に、該結紮ワイヤ５０の挟持固定を行うので、より確実に生体組織を結紮することができる。従って、結紮作業の確実性を向上することができる。
また、結紮ワイヤ５０の挟持固定及び切断操作を嵌合グリップ５６の一連の操作により行うことができるので、時間を掛けずに効率の良い結紮作業を行うことができる。特に、結紮ワイヤ５０の挟持固定及び切断が同時に行われないので、嵌合グリップ５６を力を入れずに容易に操作でき、操作性を向上することができる。 As described above, according to the medical treatment instrument 100 of the present embodiment, the first member 52 is moved in the direction of the second member 53 without passing through the lesioned portion, and the ligation wire is between the members 52 and 53. 50 can be clamped and fixed. Further, after the ligation wire 50 is fixed, the ligation wire 50 can be cut behind the clamping position by the cutting member 101. Thus, since the ligation wire 50 is clamped and fixed before the ligation wire 50 is cut, the living tissue can be ligated more reliably. Therefore, the reliability of the ligation work can be improved.
Further, since the pinching and fixing operation of the ligation wire 50 can be performed by a series of operations of the fitting grip 56, an efficient ligation operation can be performed without taking time. In particular, since the pinching and fixing of the ligature wire 50 are not performed at the same time, the fitting grip 56 can be easily operated without applying force, and the operability can be improved.

また、結紮ワイヤ５０の切断端部が第１部材５２のアーム受け部８０ａより外部に露出しないように、切断されるので、上述した挟鉗子等の他の処置具や内視鏡挿入部１０への干渉を防止することができる。
更に、切断部材１０１は、嵌合シース５５に着脱可能に設けられているので、切断の毎に交換することができる。従って、切断刃９５を新品状態にでき、切れ味が低下することはない。 In addition, since the cut end of the ligature wire 50 is cut so as not to be exposed to the outside from the arm receiving portion 80a of the first member 52, the other end of the ligature wire 50 and other endoscopes and the endoscope insertion portion 10 are cut. Interference can be prevented.
Furthermore, since the cutting member 101 is detachably provided on the fitting sheath 55, the cutting member 101 can be exchanged for each cutting. Therefore, the cutting blade 95 can be made new and the sharpness is not deteriorated.

次に、本発明に係る医療用処置具の第３実施形態を、図３６から図４０を参照して以下に説明する。なお、この第３実施形態においては、第２実施形態における構成要素と同一の部分については、同一の符号を付しその説明を省略する。
第３実施形態と第２実施形態との異なる点は、第２実施形態の医療用処置具１００では、切断刃９５がワイヤスリット１０４の先端縁に設けられて、第１部材５２のスリット１１１から外部に導かれた直後の結紮ワイヤ５０を切断していたのに対し、第３実施形態の医療用処置具１３０では、切断刃９５が、第２部材５３の側孔１１３から第２部材５３の内部に導かれる直前の結紮ワイヤ５０を切断するように配されている点である。 Next, a third embodiment of the medical treatment tool according to the present invention will be described below with reference to FIGS. In the third embodiment, the same components as those in the second embodiment are denoted by the same reference numerals, and the description thereof is omitted.
The difference between the third embodiment and the second embodiment is that, in the medical treatment tool 100 of the second embodiment, a cutting blade 95 is provided at the distal end edge of the wire slit 104 and the slit 111 of the first member 52 is used. In contrast to cutting the ligature wire 50 immediately after being guided to the outside, in the medical treatment instrument 130 of the third embodiment, the cutting blade 95 is inserted into the second member 53 from the side hole 113 of the second member 53. It is the point arranged so that the ligation wire 50 just before being led inside may be cut.

即ち、本実施形態の医療用処置具１３０の切断部材１０１は、図３６から図３９に示すように、先端アーム１０２の外周面中心に、先端から基端側の軸方向に向けて先端ワイヤスリット１３１が形成されており、また、該先端ワイヤスリット１３１の基端側に手元ワイヤスリット１３２が形成されている。そして、手元ワイヤスリット１３２の先端縁に上記切断刃９５が形成されている。
また、本実施形態の第２部材５３は、切断後の結紮ワイヤ５０の切断端部を内部に収納するワイヤ溝（線材収納部）１３３が設けられている。即ち、図３６及び図３７に示すように、大径部９１の先端側に、第１部材５２のスリット１１１から第１部材５２の外部に導かれた結紮ワイヤ５０を第２部材５３の内部に導く一対の上記ワイヤ溝１３３が形成されている。 That is, as shown in FIGS. 36 to 39, the cutting member 101 of the medical treatment instrument 130 of the present embodiment has a distal wire slit at the center of the outer peripheral surface of the distal arm 102 in the axial direction from the distal end toward the proximal end. 131 is formed, and a proximal wire slit 132 is formed on the proximal end side of the distal wire slit 131. The cutting blade 95 is formed at the tip edge of the hand wire slit 132.
Moreover, the 2nd member 53 of this embodiment is provided with the wire groove | channel (wire material accommodating part) 133 which accommodates the cutting | disconnection edge part of the ligation wire 50 after a cutting | disconnection inside. That is, as shown in FIGS. 36 and 37, the ligating wire 50 guided to the outside of the first member 52 from the slit 111 of the first member 52 is placed inside the second member 53 on the distal end side of the large diameter portion 91. A pair of the above-described wire grooves 133 are formed.

上述したように、本実施形態の結紮ワイヤ５０は、第１部材５２の固定用内腔８４からスリット１１１及び切断部材１０１の先端ワイヤスリット１３１を通って切断部材１０１の外部に一旦出て、切断部材１０１の手元ワイヤスリット１３２及び第２部材５３のワイヤ溝１３３を通って第２部材５３の内部に導かれるようになっている。また、第２部材５３の内部に導かれた結紮ワイヤ５０は、内側シース５４に挿入されて、折り返し部５０ｂを介して係合部材６６ａに係合されるようになっている。   As described above, the ligating wire 50 of the present embodiment is temporarily cut out from the fixing member 84 of the first member 52 through the slit 111 and the tip wire slit 131 of the cutting member 101 to the outside of the cutting member 101. It is guided to the inside of the second member 53 through the hand wire slit 132 of the member 101 and the wire groove 133 of the second member 53. Further, the ligating wire 50 guided to the inside of the second member 53 is inserted into the inner sheath 54 and engaged with the engaging member 66a via the folded portion 50b.

このように構成された医療処置具１３０では、図３６に示すように、結紮ワイヤ５０を切断する際、切断刃９５は切断部材１０１の外部から第２部材５３の内部に導かれた結紮ワイヤ５０を切断する。この切断される結紮ワイヤ５０は、基端方向に移動し難い状態であるので、切断刃９５が結紮ワイヤ５０に対して確実に当たることになる。つまり、切断刃９５が、結紮ワイヤ５０に対して滑りにくい角度で当たる。従って、結紮ワイヤ５０の切断をより容易に行うことができ、結紮処理の操作性を向上することができる。
また、図４０に示すように、切断後の結紮ワイヤ５０の切断端部は、第２部材５３のワイヤ溝１３３内に収納される。従って、切断後に結紮ワイヤ５０の切断端部が第２部材５３の外部に露出することはなく、他の処置具や内視鏡挿入部１０等への干渉を防止することができる。 In the medical treatment instrument 130 configured as described above, as shown in FIG. 36, when cutting the ligating wire 50, the cutting blade 95 is guided from the outside of the cutting member 101 to the inside of the second member 53. Disconnect. Since the ligating wire 50 to be cut is in a state in which it is difficult to move in the proximal direction, the cutting blade 95 reliably hits the ligating wire 50. That is, the cutting blade 95 strikes the ligating wire 50 at an angle that is difficult to slip. Therefore, the ligation wire 50 can be cut more easily, and the operability of the ligation process can be improved.
Further, as shown in FIG. 40, the cut end portion of the ligated wire 50 after being cut is housed in the wire groove 133 of the second member 53. Therefore, the cut end portion of the ligating wire 50 is not exposed to the outside of the second member 53 after cutting, and interference with other treatment tools, the endoscope insertion portion 10 and the like can be prevented.

次に、本発明に係る医療用処置具の第４実施形態を、図４１から図４６を参照して以下に説明する。なお、この第４実施形態においては、第１実施形態における構成要素と同一の部分については、同一の符号を付しその説明を省略する。
第４実施形態と第１実施形態との異なる点は、第１実施形態では、医療用処置具を生体組織の病変部を結紮する結紮装置とすると共に、線材を結紮ワイヤ５０としていたのに対し、第４実施形態の医療用処置具１４０は、出血等をしている病変部を縫合する縫合装置とすると共に、線材を縫合糸１４１とする点である。
即ち、本実施形態の医療用処置具１４０は、図４０に示すように、上記縫合糸１４１の先端に接続された抜け止めチップ（抜止部材）１４２と、該抜け止めチップ１４２を着脱自在に収納すると共に、先端に生体組織に穿刺する針部１４３を有する縫合針本体１４４とを備えている。 Next, 4th Embodiment of the medical treatment tool which concerns on this invention is described below with reference to FIGS. 41-46. In the fourth embodiment, the same components as those in the first embodiment are denoted by the same reference numerals, and the description thereof is omitted.
The difference between the fourth embodiment and the first embodiment is that, in the first embodiment, the medical treatment instrument is a ligation device for ligating a lesioned part of a living tissue and the wire is a ligation wire 50. The medical treatment tool 140 according to the fourth embodiment is a point that a suture device that sutures a lesioned part that is bleeding or the like is used, and a wire 141 is a suture thread 141.
That is, as shown in FIG. 40, the medical treatment tool 140 according to this embodiment stores a retaining tip (a retaining member) 142 connected to the distal end of the suture 141, and the retaining tip 142 is detachable. In addition, a suture needle main body 144 having a needle portion 143 that punctures a living tissue is provided at the tip.

上記縫合針本体１４４は、密巻きコイルによってパイプ状に形成されたものであり、処置具チャンネル４内で湾曲できるように可撓性を有している。また、縫合針本体１４４の先端には、上記針部１４３が取り付けられている。該針部１４３は、ステンレス等の金属部材により、先端を尖鋭な細長形状に形成されると共に、外径が縫合針本体１４４と同一になるように形成されている。また、針部１４３には、側面に開口部１４５が形成されている。この開口部１４５には、縫合針本体１４４の内孔１４４ａと連通する収納部１４６が形成され、上記抜け止めチップ１４２を収納できるようになっている。   The suturing needle main body 144 is formed in a pipe shape by a tightly wound coil, and has flexibility so that it can be bent in the treatment instrument channel 4. The needle portion 143 is attached to the distal end of the suture needle main body 144. The needle portion 143 is formed of a metal member such as stainless steel so that the tip has a sharp and elongated shape and has the same outer diameter as the suture needle main body 144. The needle portion 143 has an opening 145 on the side surface. The opening 145 is formed with a storage portion 146 communicating with the inner hole 144a of the suture needle main body 144 so that the retaining tip 142 can be stored.

上記抜け止めチップ１４２は、円柱状に形成されており、中間部の窪み１４２ａに上記縫合糸１４１の先端が縛りつけられている。該抜け止めチップ１４２は、軸方向を縫合針本体１４４の軸方向と一致させて収納部１４６内に収納されている。また、収納部１４６内には、抜け止めチップ１４２の端部に嵌合する嵌合孔１４６ａが形成されており、抜け止めチップ１４２の端部を嵌合孔１４６ａに嵌合するように、収納させることで容易に収納部１４６から脱落しないようになっている。
また、縫合針本体１４４の内孔１４４ａ内には、収納部１４６内に収納されている抜け止めチップ１４２を該収納部１４６から押し出す可撓性を有する押し出しワイヤ１４７が進退自在に配されている。該押し出しワイヤ１４７は、手元操作部６４で進退操作できるようになっている。
また、縫合糸１４１は、抜け止めチップ１４２から第１部材５２及び第２部材５３を通って係合部材６６ａに係合されている。 The retainer tip 142 is formed in a columnar shape, and the distal end of the suture 141 is bound to a recess 142a in the middle part. The retaining tip 142 is housed in the housing portion 146 with its axial direction coinciding with the axial direction of the suture needle main body 144. Further, a fitting hole 146a that fits into the end portion of the retaining tip 142 is formed in the accommodating portion 146, and the end portion of the retaining tip 142 is accommodated so as to fit into the fitting hole 146a. By doing so, it does not easily fall off the storage portion 146.
Further, in the inner hole 144a of the suture needle main body 144, a flexible push-out wire 147 that pushes out the retaining tip 142 housed in the housing portion 146 from the housing portion 146 is disposed so as to freely advance and retract. . The push-out wire 147 can be moved forward and backward by the hand operation unit 64.
Further, the suture thread 141 is engaged with the engaging member 66a from the retaining tip 142 through the first member 52 and the second member 53.

また、本実施形態においては、外側シース６５は、嵌合シース５５及び縫合針本体１４４を覆うようになっている。つまり、縫合針本体１４４は、外側シース６５内にて嵌合シース５５とは別に進退自在となるように構成されている。また、該縫合針本体１４４の操作も、手元操作部６４で操作できるようになっている。
更に、第１部材５２の先端孔８７及び側孔８８は、一対ではなく、それぞれ１つずつ形成されている。 In the present embodiment, the outer sheath 65 covers the fitting sheath 55 and the suture needle main body 144. That is, the suture needle main body 144 is configured to be able to advance and retract independently from the fitting sheath 55 within the outer sheath 65. The operation of the suture needle main body 144 can also be performed by the hand operation unit 64.
Further, the tip hole 87 and the side hole 88 of the first member 52 are not formed as a pair but are formed one by one.

このように構成された医療用処置具１４０により、病変部を縫合する場合について以下に説明する。
まず、医師は、モニタ３９に表示される内視鏡画像により、内視鏡挿入部１０の先端が縫合を行う病変部に達したことを判断すると、モニタ３９を見ながら内視鏡挿入部１０の先端を病変部の近傍に位置させる。次に、医師は、この状態で、医療用処置具１４０を処置具挿入孔１５より処置具チャンネル４内に挿入する。この際、医師は、グリップ７２を先端方向に移動させて、図４１に示すように、外側シース６５を嵌合シース５５及び縫合針本体１４４の周囲に覆うように被せた状態で処置具チャンネル４内に挿入する。 A case where a lesion is sutured with the medical treatment tool 140 configured as described above will be described below.
First, when the doctor determines from the endoscopic image displayed on the monitor 39 that the distal end of the endoscope insertion unit 10 has reached the lesioned part to be sutured, the endoscope insertion unit 10 while looking at the monitor 39. The tip of is located near the lesion. Next, in this state, the doctor inserts the medical treatment instrument 140 into the treatment instrument channel 4 through the treatment instrument insertion hole 15. At this time, the doctor moves the grip 72 in the distal direction and, as shown in FIG. 41, the treatment instrument channel 4 with the outer sheath 65 covering the fitting sheath 55 and the suture needle main body 144. Insert inside.

そして、医師は、モニタ３９に表示される内視鏡画像により、内視鏡挿入部１０の先端面より外側シース６５が突出したことを確認後、グリップ７２を基端方向に移動させて、外側シース６５を後退させる。そして、医師は、モニタ３９を見ながら縫合針本体１４４を操作して、図４２に示すように、止血しようとする病変部手間の粘膜に針部１４３を穿刺すると共に、病変部を挟んだ反対側の粘膜にも穿刺して、針部１４３を貫通させる。
なお、この際、縫合糸１４１は、縫合針本体１４４の動きを規制しないように、十分長い長さとされている。 Then, after confirming that the outer sheath 65 protrudes from the distal end surface of the endoscope insertion portion 10 based on the endoscopic image displayed on the monitor 39, the doctor moves the grip 72 in the proximal direction, The sheath 65 is retracted. Then, the doctor operates the suture needle main body 144 while looking at the monitor 39 to puncture the mucous membrane between the affected lesions to be hemostatic as shown in FIG. The side mucous membrane is punctured to penetrate the needle portion 143.
At this time, the suture thread 141 has a sufficiently long length so as not to restrict the movement of the suture needle main body 144.

この状態において、図４３に示すように、押し出しワイヤ１４７を先端方向に押し出して、抜け止めチップ１４２を嵌合孔１４６ａから外して、収納部１４６から押し出す。これにより、抜け止めチップ１４２は、縫合針本体１４４から離脱した状態となる。抜け止めチップ１４２の離脱後、縫合針本体１４４の引き抜き操作を行うことで、図４４に示すように、抜け止めチップ１４２が生体組織に引っ掛かった状態となると共に、該抜け止めチップ１４２に接続された縫合糸１４１が針部１４３によって穿刺された両粘膜を貫通した状態となる。   In this state, as shown in FIG. 43, the push-out wire 147 is pushed out in the distal direction, and the retaining tip 142 is removed from the fitting hole 146a and pushed out from the storage portion 146. As a result, the retaining tip 142 is detached from the suture needle main body 144. When the suture needle main body 144 is pulled out after the retainer tip 142 is detached, the retainer tip 142 is hooked on the living tissue and connected to the retainer tip 142 as shown in FIG. The suture thread 141 penetrates both mucous membranes punctured by the needle portion 143.

次に、この状態でスライダ７１を基端方向に操作して、操作ワイヤ６６ａを引っ張ることで、図４５に示すように、穿刺した粘膜部分を引き寄せる。即ち、縫合糸１４１が、貫通した両粘膜部分を寄せ合わして出血部である病変部を閉じる。そして、第１部材５２を粘膜部分に当接させた状態で、病変部を閉じる。その後、嵌合グリップ５６を基端方向に移動させて嵌合シース５５を引っ張り操作することで、第１部材５２と第２部材との間で縫合糸１４１を挟持しながら確実に切断刃９５によって切断することができる。縫合糸１４１の切断後、図４６に示すように、病変部が閉じた状態で縫合され、第１部材５２及び第２部材５３によって確実に固定される。これにより、病変部の縫合処置が終了する。   Next, in this state, the slider 71 is operated in the proximal direction and the operation wire 66a is pulled, thereby pulling the punctured mucosa portion as shown in FIG. That is, the suture thread 141 brings the penetrating mucosa portions together to close the lesioned part, which is a bleeding part. Then, the lesioned part is closed in a state where the first member 52 is in contact with the mucous membrane part. Thereafter, by moving the fitting grip 56 in the proximal direction and pulling the fitting sheath 55, the cutting blade 95 is used to securely hold the suture 141 between the first member 52 and the second member. Can be cut. After the suture 141 is cut, as shown in FIG. 46, the sutured portion is sutured in a closed state and is securely fixed by the first member 52 and the second member 53. Thereby, the suture treatment of the lesioned part is completed.

なお、本発明の技術範囲は上記実施の形態に限定されるものではなく、本発明の趣旨を逸脱しない範囲において種々の変更を加えることが可能である。
上記各実施形態において、係止手段を接続手段の係止孔と、接続解放手段である係合爪を利用して構成したが、これに限られず、別個に設けても構わない。
また、第２実施形態及び第３実施形態において、接続部材を連結パイプを介して嵌合シースに着脱自在に設けたが、着脱式に限られず、嵌合シースの先端に固定しても構わない。また、第３実施形態において、第１部材の先端側に筒状部材を設けた構成にしたが、第３実施形態だけに限られず、その他各実施形態に適用しても構わない。
更に、本実施形態の医療用処置具を結紮装置及び縫合装置に適用した例を示したが、これに限られるものではない。 The technical scope of the present invention is not limited to the above embodiment, and various modifications can be made without departing from the spirit of the present invention.
In each of the above embodiments, the locking means is configured using the locking hole of the connection means and the engagement claw as the connection release means. However, the present invention is not limited to this and may be provided separately.
In the second and third embodiments, the connecting member is detachably provided on the fitting sheath via the connecting pipe. However, the connecting member is not limited to the detachable type and may be fixed to the tip of the fitting sheath. . Moreover, in 3rd Embodiment, although it was set as the structure which provided the cylindrical member in the front end side of the 1st member, it is not restricted only to 3rd Embodiment, You may apply to each other embodiment.
Furthermore, although the example which applied the medical treatment tool of this embodiment to the ligation apparatus and the suturing apparatus was shown, it is not restricted to this.

本発明に係る医療用処置具の第１実施形態を説明するための、内視鏡システムの構成図である。It is a lineblock diagram of an endoscope system for explaining a 1st embodiment of a medical treatment instrument concerning the present invention. 図１に示す内視鏡装置の内視鏡挿入部先端の断面図であって、処置具チャンネル内に医療用処置具を挿通している状態を示す図である。It is sectional drawing of the endoscope insertion part front-end | tip of the endoscope apparatus shown in FIG. 1, Comprising: It is a figure which shows the state which has penetrated the medical treatment tool in the treatment tool channel. 図１に示す本実施形態の医療用処置具の構成図である。It is a block diagram of the medical treatment tool of this embodiment shown in FIG. 図３に示す医療用処置具の先端を示す断面図である。It is sectional drawing which shows the front-end | tip of the medical treatment tool shown in FIG. 図３に示す医療用処置具の先端を示す斜視図である。It is a perspective view which shows the front-end | tip of the medical treatment tool shown in FIG. 図３に示す医療用処置具の医療用結紮具を示す斜視図である。It is a perspective view which shows the medical ligation tool of the medical treatment tool shown in FIG. 嵌合シースの先端に設けられた連結フックを示す斜視図である。It is a perspective view which shows the connection hook provided in the front-end | tip of a fitting sheath. 図６に示す医療用結紮具を示す図であって、（ａ）は上面図、（ｂ）は側面図である。It is a figure which shows the medical ligation tool shown in FIG. 6, Comprising: (a) is a top view, (b) is a side view. 図３に示す医療用処置具の断面矢視Ａ−Ａ図である。It is a cross-sectional arrow AA figure of the medical treatment tool shown in FIG. 図３に示す医療用処置具の断面矢視Ｂ−Ｂ図である。It is a cross-sectional arrow BB figure of the medical treatment tool shown in FIG. 図３に示す医療用処置具の断面矢視Ｃ−Ｃ図である。It is a cross-sectional arrow CC view of the medical treatment tool shown in FIG. 図３に示す医療用処置具の断面矢視Ｄ−Ｄ図である。It is a cross-sectional arrow DD figure of the medical treatment tool shown in FIG. 図３に示す医療用処置具の断面矢視Ｅ−Ｅ図である。It is a cross-sectional arrow EE figure of the medical treatment tool shown in FIG. 図３に示す医療用処置具の断面矢視Ｆ−Ｆ図である。It is a cross-sectional arrow FF figure of the medical treatment tool shown in FIG. 結紮ワイヤにより病変部を結紮した後に、第１部材と第２部材とを互いに係止して、結紮ワイヤを切断した状態を示す断面図である。It is sectional drawing which shows the state which, after ligating a lesion part with a ligation wire, the 1st member and the 2nd member were mutually latched and the ligation wire was cut | disconnected. 図１５に示す状態の斜視図である。It is a perspective view of the state shown in FIG. 図１５に示す状態のときに、係合爪が係止孔から連結パイプの連結爪を押し出して、第１部材と嵌合シースとの接続が解いた状態を示す断面図である。FIG. 16 is a cross-sectional view showing a state where the engagement claw pushes out the connection claw of the connection pipe from the locking hole and the connection between the first member and the fitting sheath is released in the state shown in FIG. 15. 図１６に示す状態から、嵌合シースを後退させた状態を示す断面図である。It is sectional drawing which shows the state which retracted the fitting sheath from the state shown in FIG. 本発明の医療用処置具の第２実施形態を示す医療用結紮具周辺の断面図である。It is sectional drawing of the medical ligation tool periphery which shows 2nd Embodiment of the medical treatment tool of this invention. 図１９に示す医療用処置具の側面から見た断面図である。It is sectional drawing seen from the side surface of the medical treatment tool shown in FIG. 図１９に示す医療用処置具の斜視図である。It is a perspective view of the medical treatment tool shown in FIG. 図１９に示す医療用処置具の嵌合シースの先端に設けられた連結フックを示す斜視図である。It is a perspective view which shows the connection hook provided in the front-end | tip of the fitting sheath of the medical treatment tool shown in FIG. 図１９に示す医療用処置具の医療用結紮具を示す斜視図である。It is a perspective view which shows the medical ligation tool of the medical treatment tool shown in FIG. 図２３に示す医療用結紮具の上面図である。It is a top view of the medical ligation tool shown in FIG. 図２３に示す医療用結紮具の側面図である。It is a side view of the medical ligation tool shown in FIG. 図１９に示す医療用処置具の断面矢視Ｇ−Ｇ図である。It is a cross-sectional arrow GG figure of the medical treatment tool shown in FIG. 図１９に示す医療用処置具の断面矢視Ｈ−Ｈ図である。It is a cross-sectional arrow HH figure of the medical treatment tool shown in FIG. 図１９に示す医療用処置具の断面矢視ｉ−ｉ図である。FIG. 20 is a cross-sectional view taken along the line ii of the medical treatment instrument shown in FIG. 19. 図１９に示す医療用処置具の断面矢視Ｊ−Ｊ図である。FIG. 20 is a cross-sectional JJ view of the medical treatment tool shown in FIG. 19. 図１９に示す医療用処置具の断面矢視Ｋ−Ｋ図である。It is a cross-sectional arrow KK figure of the medical treatment tool shown in FIG. 結紮ワイヤにより病変部を結紮した後に、第１部材と第２部材とを互いに係止して、結紮ワイヤを挟持した状態を示す図であって、係合爪が係止孔から連結パイプの連結爪を押し出して、第１部材と嵌合シースとの接続が解いた状態を示す断面図である。It is a figure which shows the state which latched the 1st member and the 2nd member mutually after ligating a lesioned part with a ligation wire, and clamped the ligation wire, Comprising: An engaging claw connects a connection pipe from a locking hole. It is sectional drawing which shows the state which extruded the nail | claw and the connection of the 1st member and the fitting sheath was released. 図３１に示す状態のときの結紮ワイヤの状態を示す断面図である。It is sectional drawing which shows the state of the ligation wire in the state shown in FIG. 図３１に示す状態から切断部材を移動させて結紮ワイヤを切断した状態を示す断面図である。It is sectional drawing which shows the state which moved the cutting member from the state shown in FIG. 31, and cut | disconnected the ligation wire. 図３３に示す状態のときの結紮ワイヤの状態を示す断面図である。It is sectional drawing which shows the state of the ligation wire in the state shown in FIG. 生体組織を結紮した後に、再度結紮を行う場合の前処置として、挟鉗子により結紮ワイヤを切断する状態を示す断面図である。It is sectional drawing which shows the state which cut | disconnects a ligation wire with a clamp forceps as a pretreatment when ligating again after ligating a biological tissue. 本発明の医療用処置具の第３実施形態を示す医療用結紮具周辺の断面図である。It is sectional drawing of the medical ligation tool periphery which shows 3rd Embodiment of the medical treatment tool of this invention. 図３６に示す医療用処置具の断面矢視Ｌ−Ｌ図である。It is a cross-sectional arrow LL figure of the medical treatment tool shown in FIG. 図３６に示す医療用処置具の医療用結紮具を示す上面図である。It is a top view which shows the medical ligation tool of the medical treatment tool shown in FIG. 図３６に示す医療用処置具の医療用結紮具を示す側面図である。It is a side view which shows the medical ligation tool of the medical treatment tool shown in FIG. 図３６に示す医療用処置具により、生体組織の結紮後、結紮ワイヤを切断した状態を示す断面図である。It is sectional drawing which shows the state which cut | disconnected the ligation wire after the ligation of a biological tissue with the medical treatment tool shown in FIG. 本発明の医療用処置具の第４実施形態を示す、挿入部先端の断面図である。It is sectional drawing of the front-end | tip of an insertion part which shows 4th Embodiment of the medical treatment tool of this invention. 図４１に示す医療用処置具の縫合針本体により、病変部周辺の粘膜を穿刺した状態を示す図である。It is a figure which shows the state which punctured the mucous membrane of a lesioned part periphery with the suture needle | hook main body of the medical treatment tool shown in FIG. 図４１に示す医療用処置具の縫合針本体から抜け止めチップを離脱させた状態を示す縫合針本体の側面図である。FIG. 42 is a side view of the suture needle body showing a state in which the retaining tip is detached from the suture needle body of the medical treatment instrument shown in FIG. 41. 図４１の状態から、縫合針本体を引き抜いた状態を示す図である。It is a figure which shows the state which pulled out the suturing needle main body from the state of FIG. 図４３の状態から、縫合糸を引っ張り病変部を閉じるように粘膜を重ねた状態を示す図である。It is a figure which shows the state which piled up mucous membrane so that the suture thread was pulled from the state of FIG. 43 so that a lesioned part might be closed. 図４５の状態から、ストッパにより縫合糸を固定した状態で、該縫合糸を切断した状態を示す図である。FIG. 46 is a diagram illustrating a state in which the suture is cut from the state of FIG. 45 in a state where the suture is fixed by a stopper.

符号の説明Explanation of symbols

１、１００、１３０、１４０ 医療用処置具
５０ 結紮ワイヤ（線材）
５１ 線材操作部
５２ 第１部材（第１の線材保持部材）
５３ 第２部材（第２の線材保持部材）
５４ 内側シース（第１のシース）
５５ 嵌合シース（第２のシース）
５６ 嵌合グリップ（シース操作部）
５７ 接続手段
５８ 係止手段
５９ 切断手段
６０ 係合爪（接続解放手段）
７６ 連結フック（突出部）
７６ａ 爪部
８９ 係止孔
９５ 切断刃
１０１ 切断部材
１３３ ワイヤ溝（線材収納部）
１４１ 縫合糸（線材）
１４２ 抜け止めチップ（抜止部材）
１４３ 針部
１４４ 縫合針本体 1, 100, 130, 140 Medical treatment instrument 50 Ligation wire (wire)
51 Wire operation part 52 1st member (1st wire holding member)
53 2nd member (2nd wire holding member)
54 Inner sheath (first sheath)
55 Fitting sheath (second sheath)
56 Fitting grip (sheath operating part)
57 connecting means 58 locking means
59 cutting means 60 engaging claw (connection release means)
76 Connecting hook (protruding part)
76a Claw part 89 Locking hole 95 Cutting blade 101 Cutting member 133 Wire groove (wire storage part)
141 Suture (Wire)
142 Stopper Tip (Retention Member)
143 Needle portion 144 Suture needle body

Claims (9)

生体組織に対して所定処理を行う可撓性の線材と、
該線材の進退操作を行う線材操作部と、
前記線材に対して進退自在に設けられ、線材を保持する第１の線材保持部材と、
該第１の線材保持部材の基端側に軸方向に進退自在に設けられ、第１の線材保持部材との間で前記線材を挟持可能な第２の線材保持部材と、
該第２の線材保持部材の基端側に当接して設けられた可撓性を有する第１のシースと、
該第１のシースを覆って第１のシースに対して進退自在に設けられた可撓性を有する第２のシースと、
該第２のシースの進退操作を行うシース操作部とを備え、
前記第１の線材保持部材及び前記第２のシースが、互いを接続させる接続手段を有し、
前記第１の線材保持部材及び前記第２の線材保持部材が、前記線材を挟持したときに、互いを係止する係止手段及び線材を前記挟持位置よりも基端側で切断する切断手段を有し、
前記第２の線材保持部材が、第１の線材保持部材に係止されたときに、前記接続手段の接続を解く接続解放手段を有することを特徴とする医療用処置具。 A flexible wire that performs a predetermined treatment on a living tissue;
A wire rod operation unit for performing the advance / retreat operation of the wire rod;
A first wire holding member that is provided so as to be movable forward and backward with respect to the wire, and holds the wire;
A second wire holding member provided on the base end side of the first wire holding member so as to be movable forward and backward in the axial direction and capable of sandwiching the wire with the first wire holding member;
A flexible first sheath provided in contact with the proximal end side of the second wire holding member;
A flexible second sheath that covers the first sheath and is provided so as to be movable forward and backward with respect to the first sheath;
A sheath operating portion for performing the advance / retreat operation of the second sheath,
The first wire holding member and the second sheath have connection means for connecting each other,
When the first wire holding member and the second wire holding member hold the wire, the locking means for locking each other and the cutting means for cutting the wire closer to the proximal side than the holding position. Have
A medical treatment instrument comprising: a connection releasing means for releasing the connection of the connecting means when the second wire holding member is locked to the first wire holding member. 請求項１に記載の医療用処置具において、
前記切断手段が、前記第１の線材保持部材の内部にて前記線材を切断することを特徴とする医療用処置具。 The medical treatment tool according to claim 1 , wherein
The medical treatment instrument, wherein the cutting means cuts the wire inside the first wire holding member. 生体組織に対して所定処理を行う可撓性の線材と、
該線材の進退操作を行う線材操作部と、
前記線材に対して進退自在に設けられ、線材を保持する第１の線材保持部材と、
該第１の線材保持部材の基端側に軸方向に進退自在に設けられ、第１の線材保持部材との間で前記線材を挟持する第２の線材保持部材と、
該第２の線材保持部材の基端側に当接して設けられた可撓性を有する第１のシースと、
該第１のシースを覆って第１のシースに対して進退自在に設けられた可撓性を有する第２のシースと、
該第２のシースの先端に設けられ、前記線材を前記挟持位置よりも基端側で切断する切断刃を前記線材より先端側に配する切断部材と、
該第２のシースの進退操作を行うシース操作部とを備え、
前記第１の線材保持部材及び前記第２のシースが、互いを接続させる接続手段を有し、
前記第１の線材保持部材及び前記第２の線材保持部材が、前記線材を挟持したときに、互いを係止する係止手段を有し、
前記第２の線材保持部材が、第１の線材保持部材に係止されたときに、前記接続手段の接続を解く接続解放手段を有することを特徴とする医療用処置具。 A flexible wire that performs a predetermined treatment on a living tissue;
A wire rod operation unit for performing the advance / retreat operation of the wire rod;
A first wire holding member that is provided so as to be movable forward and backward with respect to the wire, and holds the wire;
A second wire holding member that is provided on the base end side of the first wire holding member so as to be movable forward and backward in the axial direction, and holds the wire between the first wire holding member;
A flexible first sheath provided in contact with the proximal end side of the second wire holding member;
A flexible second sheath that covers the first sheath and is provided so as to be movable forward and backward with respect to the first sheath;
A cutting member provided at a distal end of the second sheath, and a cutting blade for cutting the wire rod on the proximal side from the sandwiching position, the cutting member being disposed on the distal side from the wire material;
A sheath operating portion for performing the advance / retreat operation of the second sheath,
The first wire holding member and the second sheath have connection means for connecting each other,
The first wire holding member and the second wire holding member have locking means for locking each other when the wire is sandwiched,
A medical treatment instrument comprising: a connection releasing means for releasing the connection of the connecting means when the second wire holding member is locked to the first wire holding member. 請求項３に記載の医療用処置具において、
前記第２の線材保持部材が、切断後の前記線材の切断端部を内部に収納する線材収納部を有することを特徴とする医療用処置具。 The medical treatment tool according to claim 3 ,
The medical treatment instrument, wherein the second wire holding member has a wire storage portion that stores therein the cut end portion of the wire after cutting. 請求項３又は４に記載の医療用処置具において、
前記切断部材が、前記第２のシースに着脱可能に設けられていることを特徴とする医療用処置具。 The medical treatment tool according to claim 3 or 4 ,
The medical treatment instrument, wherein the cutting member is detachably attached to the second sheath. 請求項１から５のいずれか１項に記載の医療用処置具において、
前記接続手段が、前記第２のシースから先端方向に突出すると共に先端に第２のシースの内部に向けて突起した爪部を有する突出部と、前記第１の接続部材の外周に設けられて前記爪部に係止可能な係止孔とからなり、
前記接続解放手段が、前記係止状態のときに、前記係止孔内に嵌合すると共に前記爪部を係止孔から押し出し可能な係合爪であることを特徴とする医療用処置具。 The medical treatment tool according to any one of claims 1 to 5 ,
The connecting means is provided on the outer periphery of the first connecting member, and a protruding portion having a claw protruding from the second sheath toward the distal end and protruding toward the inside of the second sheath at the distal end. It consists of a locking hole that can be locked to the claw part,
The medical treatment instrument, wherein the connection release means is an engaging claw that fits into the locking hole and can push out the claw portion from the locking hole when in the locked state. 請求項６に記載の医療用処置具において、
前記係止手段が、前記係止孔と前記係合爪とからなることを特徴とする医療用処置具。 The medical treatment tool according to claim 6 ,
The medical treatment instrument, wherein the locking means includes the locking hole and the engaging claw. 請求項１から７のいずれか１項に記載の医療用処置具において、
前記線材が、生体組織を結紮する結紮ワイヤであることを特徴とする医療用処置具。 The medical treatment instrument according to any one of claims 1 to 7 ,
A medical treatment instrument, wherein the wire is a ligation wire for ligating a living tissue. 請求項１から７のいずれか１項に記載の医療用処置具において、
前記線材が、生体組織を縫合する縫合糸であり、
該縫合糸の先端に接続された抜止部材と、
該抜止部材を着脱自在に収納すると共に、先端に生体組織に穿刺する針部を有する縫合針本体とを備えることを特徴とする医療用処置具。 The medical treatment instrument according to any one of claims 1 to 7 ,
The wire is a suture for suturing a living tissue;
A retaining member connected to the distal end of the suture;
A medical treatment instrument comprising a suture needle main body having a needle portion for puncturing a living tissue at a distal end while detachably storing the retaining member.
JP2003349572A 2003-10-08 2003-10-08 Medical treatment tool Expired - Lifetime JP4480978B2 (en)

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WO2005034770A1 (en) 2005-04-21
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JP2005110984A (en) 2005-04-28
EP1683492B1 (en) 2012-08-22

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